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FOR OFFICE USE: II � / I �� g _ ----------------- APPLICATION FOR SANITATION PERMIT Permit No. ...,..1..__. .___,.. 1 z 6v: -�1'��_ - 1 (Complete in Duplicate) Date issued .... f.r�'�e_ --------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549.) JOB ADDRESS AND LOCATION_—....--•--l---/`� �C).1. .(.�1�' , Owner's Name---� . __ .. -- --•----- -- - - --------••-.. F��'-��_-_�.�� I Address....t _ _ .... ... Contractor's Name- -_ - ----- ---•-•------ t � � x.............................. Installation will serve: Residence ❑± partment Ho e ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oth Number of living units: ________ Number of bedrooms _______. Number of baths ........ Lot size 1.1- --- ...: .1... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablea ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [] Previous Application Made: (If yes,date--------------------) No Er'O'New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool p 4rmitted if public sewer is available within 200 feet.) ` Sep^tic �Tank: Distance from nearest well__ '_____Distance from foundation_1..._9.-__.__.Material...__cc___`�r P1... No. of con artments_ A._ _Size--,"--- �L�uid de th_ yi -__..Ca aci 4 d 1� P I ` X i. q R , P tY I Disposal Field: Distance from nearest well_ __.•_Distance from foundation--- to nearest lot lin e� _..____.___. Number of lines_____________-(__________i__._ ength of each line------- Width of trench_____ _...__............ r Type of filter materia pth of filter material ._y Total length_- -------.._._. I Seepage P• Distance to nearest well----/_0 0-______Distance from foundation___21D_/___.Distance to nearest lot Number of pits... __________Lining material_._. ----Size: Diameter__ ------Depth------2S______________ k Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------- __ ........._ ._ - \! --- ❑ Size: Diameter-- -------------------------------•-Depth----•-----------------------------------------------Liquid Capacity---- ----------------e ls- Privy: Distance from nearest well___----------------------------------------------Distance from nearest building--_--___--_------------------------------- ❑ Distance to nearest lot line--------- -------------- ----------------------- ---- -- M Remodeling and/or repairing (describe):---------------------------------------------•------••••-------•-------------------------•--------------•--•----------------•---------••--=---••---•---- --•--••----•----••---.-....--•-••----------------------•.----1 •- _ -- _„-------------------- -- -----------------•--------------------------------------------- •-- o .. -- ----•------•---•----•---•-••---- •--------------------••------•------ --- -------- --------•-I--••--•--------•----------------------------------- --------------------- ---------------------------------------------------------------------------------- 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 es and regulations of the San Joaquin Local Health District. (Signed)f��-�-�-----�''•-• � -1 - --------------------------------------(Owner and/or Contractor) i By------------------------ �” - ---------- -------------(riifle)----- -----•------------------------------------- -------------- (Plot plan, showing size. of lot, location of system in rely n to wells, buildin etc., can be placed on reverse side). FOR 0 EPARTMENT USE ONLY a� APPLICATION ACCEPTED BY--- n ------------------------------------------- DATE--1--�---L.. y-'- 2"----------- �.. REVIEWEDBY------------------------------------------ ----------------------------------------------------- DATE---------------------------- ---•-----•------------------- BUILDING PERMIT ISSUED---------- ---------------------------------•-----------•-----------------------------------------•-- DATE------------------------------------------------------------ Alt rats ns and/or recon enatiorts: ----------------------- _1711 f + in -t-----.•--•-- r ._. - �- - - -- -- -- ---------- FINAL INSPECTION - -__-- f._ __.2 _ ------ ---. - - SAN �— JOAQUIN LOCAL HEALTH DISTRICT 130 South Ari,orican Strout 300 West Oak Srroot 144 Sycamore Strout 405 West 9th Strout Stockton,California Locil,California Manteca,California Tracy,California i ES 9 REVISED B-59 iM a-61 ATLAB