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FOR OFf ICE USE: ------------------=--------;----- --------------------- / 7---- APPLICATION FOR SANITATION PERMIT Permit No. .1 -------•-••_-- (Complete in Duplicate) 7 a 3. ' ' .�.- c�r vim-�Q✓E 3 Date Issued .___ This Permit Expires 1 Year From Date Issued .2� - -o - 2�/ov --1.3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described., This app f ti is made in compliance with County Ordinance No. 549. R r� -. JOB ADDRESS AND CATION ` M �@�� -----�q F Owner's Name------ -------------------------------------------------------------------._. Phone--------------------•--------------- Address---------------- .- _ --------' `� R' ' -41 �, Contractor's Name I_ _�Tif_ .. -------•-------------------••-- Phone_-------------------------------- Installation will serve: Residence eAparfment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms --5._ Number of baths!_ . Lot size ____,_s___ Water Supply: Public system E] Community system El Private Depth to Water Table .-6.- ft. Character of soil,to-a depth of 3 feet: Sand Gravel ❑ jSandy Loam ❑ Clay Loam E] Clay ❑ Adobe ❑ Hardpan ❑ f r~ I No New Construction: Yes .6.-- ❑ FHA/VA: Yes ❑ No Previous Applicati�o` Mads: {1f yes,dote_..__..__ ._ s . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic,tank`.or cesspool permitted if public sewer ijavailable within 200 feet.) r� Septic Tank: Distance from nearest;well-_-.____ _Distance from foundation_ ._ _____. __ ..Material) ______________________________ STI n�'G'� No. of compartments Size --------- -- - ------Liquid depth ------- -- ; P y-------------- Disposal Field: Distance from nearest well__:�----Distance from foundation--------------------Distance to nearest lot line_______-________ �V� ®tel Number of lines-------- --_..__ _Length of each line__�_ .��_ ____.Width of trench _rf______________ i l y� T + - Type of filter material--dry-Q-CYC___Depth of filter material-____1 _ �-_____Total length______ ___i______________, Seepage Pit: Distance to nearest well_------------------(Distance from foundation-------------------Distance to nearest lot line______________. ❑ Number of pits----------------------Lining#material-----------------------Size: Diameter----------------- Depth------------..................... 4,4 r Cesspool: Distance from nearest well------- ____-Distance from foundation__________________Lining material----------------------------------- 4 El PSize: Diameter__.$.---- ------ ----- _------ Depth------------------------- ----------------Liquid Caacigals. I *0 .1 1 ,r 1 Privy: Distance from•nearest well_____________________________--_________-______Distance from nearest b0dilg---_____________________-_--------------- ❑ r --».... -- ------- -- .-- -------- 17 Distance to nearer} lot'Ilne-------- ---------------'- � -____-- _ -- -. ----__-_-- __-- - � � � -- Remodeling and/or re' airing (deRcnbe): J'�VV '}a-^�- _�^��` T- -- ` ,; ------------------------------ ----------------------- ------------------------------------------------------ 1--9---0¢------------------------------------------------------------------"-----------------fir+ >< hereby certify that--]-have-preparei this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule nd regulation of the San Joaquin Local Health District. " C (Signed] ----- - ; ;= :: (Owner and/or Contractor) C . By:-------------------------------------------------- ---------- --------------------------------------------------------------------(Title)------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY S APPI_ICATiON ACCEPTED BY-------- ='------------------------I--------------------------------------- DATE------- --- 7_ ------------------ REVIEWEDBY------------------------------- ---- ------------- ------ ---- ------- ------- --------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMITISSUED---------------------------------- -------------------------------------------------------------- ---- DATE------------------------------------------ -------------- Alterations and/or recommendations------------------ ----------------•--•---------•----•-------------•-------------------•--•-------------------------------- ,M tsrl -% a .01 % _N -• •-------------- ------------------------------------------------ - ------ -------- ----- ------------;;; --------------------------------------------------------------------------------------------•---- ----- ----------- -- -------------- --- ----------------------------------------- -------------------------------- --------------------------------------- - ------ - ----------------- -- -- --- -------------------- I FINAL INSPECTION --------------------- :. --- .... . Date------------- ��- --- --------�' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3-'63 F.P.CD.