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�o R OFFICE USE: 3� ----- ----------------"""�' " 3 7 --------------- APPLICATION FOR SANITATION PERMIT Permit No. ._l ------- ------------------------------------------------- (Complete in Duplicate) Date Issued ------------------------------------ This permit Expires 1 Year From Date Issued X�6 15-7--Application /6, r f, -7--3 d� �e�d Application is hereby made to the San Joaquin Local Health District for a permit to constructiAnd install the work herein escrib . This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION...... .10 " J, .11:j. --7 AV-- _-10 ------- ----•----------- Owner's Name t'�1� x - ---------- Phone T_ls -----------5 Addresst � 1 ��► -•--'-------------------------------------------------------------------- -•--------------------------------------------------- Contractor's Name fi� ------- -------••----•-----------------•-'---------------------------- ------ Phone----------------------------------- ------------------------------------------------------------------------ will serve: Residence 09--'Kpartment House ❑ Commercial ❑ Trailer Court ❑ Mjottel ❑ Other ❑ Number of living units: __/_ Number of bedrooms _ . Number of baths ___ Lot size , ,Ct -,- Water Supply: Public system �ommunity system El Private L] Depth to Water Table A7 ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: {If yes,dote----------_---------1 No /''New Construction: Yes �No ❑ FHA/VA: Ys o E-]TYPE OF INSTALLATION AND SPECIFICATIONS: q -7 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) '00, 1��/ Septic Tank: Distance from nearest well--- _---Distanceyy from foundation___AV 5-------------- ®� No. of compartments...A------------------SizeC___ _ .._--__Liquid depth_-.- �_____________Capacity___ -_ .. Disposal Field: Distance from nearest well__-0r•,P_.._Distance from foundati n.- . W_J#____-Distance to nearest lot lipe�-/.___ . Number of lines__________ __-__--___-- �W r _ Length of each line___ �_.____ -.Width of trench______ _________________________ Type of filter material_ Depth of filter material__ __ Total length__ _ _ Seepage Distance fo nearest well---� _____Distance fm fou dation___ �. Distag a to nearest lot ii e_ 7!�___lNumber of pits-----�_._________Lining materia -Size: Diamete'?Y------.----Depth�.� e<0 Cesspool: Distance from nearest weil-----------------Distance from foundation----------------._-.Lining material-------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, rn Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------------.-. ❑ Distance to nearest lot line------------------------------ ------------ ---------------------------------------------------------- Remodeling and/or repairing (describe):---- / -- --------------•----------------------------------------- , - --------------------------------------------------------------------------------------•-------•-----------•-----------------------7-------- -------------•-•-------------------------------------•------------------------ ---- ---- -----------�----------------------------- -------------•-------------------------------------------------------------------------•-----------------------------•-----------------•---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru s and regulations of the San Joaquin Local Health District. (Signed)------------------- - -- -------.�—- —— - - --------------- ---------------------- Q�r Contractor) - ----------------- B ------------------------------- - -------- ----• Title---- y ( ----- ---- - ----------- -- (Plot plan, showing size of lot, location of system ' elation to wells, buil ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- ---_—---------------------------------------------------------- DATE--------1=3- =4___?----------------------- -- REVIEWED - =4 -?--------- ---------------- REVIEWEDBY------------------------ ------------ ------------- --------------------------------------------------•----------------------- DATE------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------- ----------------------------------------------- --------• DATE---------------------- ------------ ------ -- _ Alterations and/or recommend tions:------------------------------------------ •---- ---------------------------------------- ---- -- --------- �� ` ----- -- -- --- --- - ------ - �- ---------------- ---------------•-- . .. ----------- ------------------ � � �'---.- -- � -_ter `-`�--- - -------- - -------- - --------- ------ --- - ------- - --------------------------------------- ---------------- ----------------------------------------------- ------------- I---------r--------------14V------- ------- ------------ -------- FINALINSPECTION BY------------------------------------------ --------------------- att�e-.--------- -------------------------- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1861 E.Haadton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9.59 3M 3•'6:3 F.p.CD.