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FOR OFFICE USE: --"-- -- l/ _-_ - `--"'7/ -`/,-----_ ;��- APPLICATION FO _ -_-_ .R SANITATION PERMIT � Permit No. .J.7- ___-_ ' (Complete in Duplicate) '/ ° _.__- This Permit Expires 1 Year From Date Issued Date°Issued______ _GC- _--le ---------------------------------- k Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION- }Al / !_.------ ��/.,1/llS��----------------------------------------------=--------- i Owner's Name--------- --i {4�-------------- ----- = Phone Address---------------------------------------------------- ` ' -- Al 70 •'' - •• ---------------•------- Contractor's Name---------- •------ ---a-�---- � -------------------------------------=-------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units:.-_j___ Number of bedrooms___ Number of baths /-___ Lot size ----- Q - Water Supply: Public,system Qj,, Community system ❑ -Private ❑ Depth.to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ad e ❑ Hardpan ❑ Previous Application Made: (If yes,date_------------------) No ❑ New Construction: Yes ❑ No HA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted,if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material _______-----__-_________--___-____---__-_-_-___- ❑ No. of compartments------ -------------- ----Size--------------------------__Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well - Distance from foundation--------------------Distance to nearest lot line-------_________- ` [] Number of lines-----------------------------------Length of each line------------------------------Width of french----------------__------:---------- y Type of.filter material-------------------------Depth of filter material---------_-_-_____.----Total tII t , y length_______-_____-_-__-____ _____ _ ______ fdationDistance to nearest lot line__._ -_-_-_-_-_-_-_---_- _ ' SeepaDistance to nearest well______ _ Distance f 6 _ a� ____Cg iNumber of pits----F-.---_-,--------Lining material____- _Size: Diameter-aK_//-_--__-_Depth0 2-0 Cesspool: Distance from nearest well----------------- from foundation------------------_Lining material------`.---__-___--___________--__- Size: Diameter-------------------------------------Depth,--------------------------------------------------Liquid Capacity--. gals. Privy: Distance.from.nearest well-------------------------------------------------Distance from nearest building------------------------------- _----_. ❑ Distance to nearest lot line------ =- -- --- ---- --- t --------- -------- -------�+--------- ------=------------------------- Remodeling and/or cepa{ring (descr;be):-------------- � { - L ------------------------------- ------- " ----------- ------ - - ------------------•---------------------------- ---------------------------------------- �+ ----------------------------------------------.------------------------------------------------------------------ ------------------------------------------------------------------•------------------- - ------------ 111 I hereby certify that`I have pre red this application and that the work will be done in accordance with San Joaquin County 0 ordinances, State Lyws; -a d rules an r ul ' ns of t n Joaquin Local Health District.. 1T (Signed) --------- --- ... s--- ---------- ------------------------------------------------(Owner and/or Contractor By:--------------------------------------- -- - - -- ---- - -- ---------------(Title)------- -- ---- ------ (Plot plan, showing size of lot, Io do o system in'relation.to�rre�s!buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- , '----------------------------- DATE-----7/ ` � --------------- REVIEWEDBY----------------------------------------------------------- --- ------------•--------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------- -----— DATE . . Alterations and/or recommendations:___ :.__. .___ _--__.t -_ 3`--- =--- -•---- -.----------------------- ---------- --------------------------------------------------------------t---------- I " ------------------------------------------------------------------------------------------------------------------ ------- ----------------------------------------------------------- - -------------------------------------------;-------------------- -•----------------------------------------- ------------------------ ---------- -------- ------------------------ -------------------------- ----- FINAL INSPECTION BY -� =aDate----- �--�-�----------------------- — f AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California _ Manteca,California Tracy,California • ES 9 REVISED a3 59 3M 3-163 F.P.CD. ,