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� FOR-OFFICE USE: � yLG'! --- � __---.--- APPLICATION FOR SANITATION PERMIT Permit No. .___,1 _.� ---------------------------------------- - `/ ------- ----------------------------------- ------ (Complete in Duplicate) �Yz4-- --- h Date Issued __.:.___ ________ ---------------------------__.--------_,.----.__..___ This Permit Expires 1 Year From Date Issued i 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. 7 YJOB ADDRESS AND LOCATION ---• --------------------------------------------------------- Owner's Name-- - - - ----- Phone , Address •-•-•--••-•----------------------------•-- ` •---------•-------------•-------------=-------------------• ------••--------------------------•--- Contractor's Nameu�.,. - ----- ' d.P -- �) --- ---- ---� -- ------_-•--•-_---_--.. Phone__4�1X 5^ -- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �, Number of living units: I--- Number of beclrooms= Number of baths --I-_ Lot size _--------__l.___Z_t ______________ 1 Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 46_pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2 iardpan ❑ Previous Application Made: {If yes,date....................) No ❑ ' New Construction: Yes ❑ No Z4-- FrA/VA: Yes ❑ ;No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se c T,,*--- Distance from nearest well---------------- Distance from foundation--------------------Material---.._______._..__-______.._________.._.___.____. No. of compartments------":_ ---Siz"e---------------------------------Liquid depth.----------.--------------Capacity-- I �f' 19 cW Di salt -ICILJ�: 'stance from near st weIL�QA.��_.Distance from foundation___ _ distance to nearest lot line_____ ___.._ t Number of lines_______ �`~• - _ _Length of each line__ _ �_ Width-of trench_._ J Type p k oI 9 6 .16" T e of filter material-- De th of filter ma ersal________�_ ._ Total length- Y------ Seepage Pit: Distance to nearest well-1-QMe-_---Distance rom foundatior�-457V 7V...___.Distance to nearest lot line------ i Number of pits---- Linin material_- -- ____.Size: Diameter_ _x �r_��'_- epth__-/Ci> `_______________ p g �.Ja� Cesspool: Distance from nearest well...............-__DistanceJrom undation--------,_--------- Lining material-----------------------------"`---- ❑ Size: Diameter---------------+--- -, -;r-"-.;De .. - --------"---------------------------------------Liquid"Capacity-- ------------------- gals. • Privy: Distance from nearest,we'll---.--_ -__.__:_____ ______________ ___Distance from nearest building------------------------------?-___- �-- t� ❑ Distance to,nearesry � . ------- I ------------------------------------------•-------- Remodeling and or repairing (descrai ) -------------- --- ----------- -- ------------------------------I --- - - ------------------------------------------------------• `I •-------------•----- I hereby certify that I have prepared this application and ihg# the work will be o e in cordance with San Joaquin County ± ordinances, State I ruI s and regulations of th San J ui Local Ith D' riot. (Signed) ^G1 - Contractor) ► k By:-------------------------------------- ---------------------------------------------- -- - -------- --- ------- -+--- (Title)_---------------- -------- - (Plot plan, showing size of lot, location of system in relation to ells;buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY rG" a^'� DATE REVIEWED BY------------------------------------- � BUILDING PERMIT ISSUED------------------------------------- ------------------ . — DATE - ---€---- i s: Alterations and/or recommendations:__._-- _ ____.___, Z ._ ___, _yf ----- -� - — = ---------- ----------------------------------------•------------ ----------- - --------------------------------------------------------------------------------------------------------- ------------------------------------- ---------------------------------------------- ------------------------------ ------ ------------------------------------------------------------------------------------------------------------------------------------ ---------------------•- - ------ - --- -- - -------/--------------------------------------------------------------------------------------------•----------------`--------------------------------------------------------- FINAL INSPECTION BY:.... ---- --- - --- �/ � -� Date - --------------------- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naseltan Ave. 00 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVIS&P E-S9 3M 3-'63 F.P.00.