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FOR OFFICE USE: ----------- APPLICATION FOR SANITATION PERMIT Permit No. 716... ................ ------- -- ------------- -------------- �. .. .� (Complete in Duplicate) / - 2 Date Issued --f'`�-__-6J _ :.r---------------- ----------- _____.__._._ 'This Permit Expires 1 Year From Date Issued licaon is.hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. • Apption application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.�---I_/.�� ,!_--- (�.k _C-------------Vi�� -----•--------------------------------------------------- .f Name----- ... �---------�'!1-�5-� ��t �_ -��------------------ ---------------------------------------_l? /1- ------T� hone Address------------------- I -----' ��x_------ � ---- ----------- -------•---•-•------- -----------I----�--- .` _/s f. "T'4-l".. �'Y-e '- ` .-------------- Phone---------------------------------- Contractor's Name-----1 �'+ ------- ------ �-:lr- -- Installation will serve: Residence PeartrTienfi House ❑ Commerciale❑ Trailer Court ❑ ,Motel ❑ Other ❑ , Number of living units:.--f---- Namber of bedrooms l3__ Number of baths" Lot size _-.__ _1-�r f Water Supply: Public system ❑ Community system ❑ Private Depth to Water=Table//,0- ft. Character of soil to:a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loaf ❑ Clay ❑ AdobeH�rdpan ❑ Previous Application Made: (If yes,date------------------ -) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OFIINSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed,if.public sewer is available within 240 feet.) / I I Septic Tank: Distance from nearest well-,VV-4-: Distanc frpoom/foun0tion_-_4------_--Mater�l_R��________________________ No. of compartments -------------��...J.Size__ p--�.___•___Liquid depth__._..r-----.--__.-_.Capacity_ - ----- wr r. .NA `?� F I wry f4Disposal Field: Distance•.firom nearest,well _} _.__Distance from foundation...._ _ Distance to nearest lot lire----------------- Number of lines_______________ .___Length of each line_______ Width of french________.._._ _4e th of filter. material________. ��____Total length---.___-__- _/-_-_-______---- YP ` # P Seepa Pit: Distance to nearest well-___/_ T e of filter materia __ -- � P -_.-Distance from fdondation-----AV.........D�tance�o nearest lot line--_,rte". _. Size: Diameter__ i Number of pits-------- ______Llning material__ / _ ..__-Depth_.`l '_ _ _ _. 1. Cesspool: Distance°from,-nearestwell-._-.:-f-___Distance from foundation--------------------Lining material........_________________________-_-- Size: Diameter-------------------------------------De th------------------------------------- --------------Liquid Capacity gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ A ! ❑ Distance to nearest lot line--------------------------------------------- -------------------------•--------------•------- ----------------------------------------------- Remodeling ------ -------------------------------Remodeling and/or repairing (describe]--------------------------------------'------------------------------------------------------------- ---------------------------------------------------- I ------------------------f--'-----------------------------------------------------=--------------------------------------------------------------------------- -------- ------------------------------------- .i k ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan�e s,.St ate,laws,,and,rules and regulations of the San Joaquin Local Health District. ' (Signed) --------------------------------------------------------------- --------------------.-.-.(Owner and/or Contractor) --- _--------------------------------------------------- (Plot -'-------- ----------------------------------- (Title)_ � Y = { )-- ------- (Plot plan, showing sizWof'tiot,tlocation of system in relation to wells, buildings, etc., can be placed oh. reverse side). 4 t 3 FOR DEPARTMENT USE ONLY ;' APPLICATION ACCEPTED BY------------ e�-------------------------------------- -------------- -------------------- u •rte---::"t-r REVIEWED BY --- ----- -------- 1 � « ------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------=------ g�a,tons a Alti ----- ----..-----------:.' - ; e-- - ------------------ �______________________ ______ � _-f ..r _'1 ---------------------------------------------------------------------------------.._.:._-_.-_._._;-_-_._-_-----._-_-_--_---_-:---------_.,_---------_---..---_-_-__----_____-_-_1l_a-_----._.-__-_-__-_-_-__--.__-_-___.---- r .. R FINAL INSPECTION BY:- `" Date- f ----- - ----- SAN JOAQUIN LOCAL'HEALTH DISTRICT,."\,;\ 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Stfeet 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 b REVISED B-54 3M 3•163 F.P.0 n. .moi