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FOR OFFICE USE: ' �� -----__ --..-- f;` - APPLICATION FOR SANITATION PERMIT v Permit-No.--/ 1 _.., 7.... ------- --------------- - - [Complete in Duplicate) Date Issued �5 _-4 GF{ C---- { .._.. _ j -_ _._I_ ______________`��------_..__. 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 A�D�LOfCCTION- - � C-ke �------------------------------------- ------- ---- Phone------------------------------------ Owner's Name---- U- --------- _ ----------------- -- ------------------- Address ----- Address-----------------• ------- / �'v,/r D=O..e...��!i�------. ------ Contractor's Name--------•-•-- RC1- -.-. G, �)__&'-c--------------------------- ----•--- ---------------------------------------.._._ Phone---••--------------._----------- Installation will serve: Residence ❑Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..----- Number of bedrooms ._�?�Iumber of baths 1----- Lot size __________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 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 ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,.. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta : Distance from nearest we -----------Distancel from foundation-_�_ _ Material-et, 'g Y' G Q________. __ No. of compartments__________________.____Size__�ra_- ��_ _____Liquid clepfh__/71- 2ri--------__Capacity..._r �___.___ Disposal F' d: Distance from nearest well._'Distance from foundation_ _____.__.Distance to nearest lot linej-/___-__ Number of ines____ -_-_ _ Len th of each line____________ ___.___________.Width of trenc h. .___-� ..Type of filter material_#__) _ _________Depth of filter material___ Total length t t� Q Seepage Distance to nearest well_____ Distanc fr( Ao�undation___,/0�. / Distance to nearest lot Iin7__5---------- Number of pts-- ----)... ____Lining material_ ._fh-44Sze: Diame4r� r�------DepthoZ_ ._/__ Cesspool:. , Distance from nearest well-._____'--------Distance from foundation--------------------Lining material--- ----_-.-_________________._ ❑ Size: Diameter-------------------------- ------ --._Depth--------- ------------------------------------------Liquid Capacity--..------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building----------------------------------------- ❑ Distance to nearest lot line-- ---------------------------------------- -----------------_--------------------------------------------------------------------------- 'f Remodeling and/or repairing (describe):--------------- ------ -------------------------------- ------------- i --- O ------------------------------------ -----------------------------•------------------------------------------- ----•------------------------•-----------------,--------------------------------------------------------- I hereby certify that I have 6preared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, nd rulesegulati ns of the San Joaquin Local Health District. (Signed)---------------- ---- --- ----- Owner and/or Contractor] By:------------------------------- ------... ' -------------------------------------------(Title) - --- -------------- (Plot plan, showing size of , location of system in relati n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------:------ ll ------------------------------------ DATE----�1---- f - --------- -- REVIEWEDBY--------------------------------r-------------------I-------------I----------- --- -------------------------------------- DATE----------------------------- BUILDINGPERMIT ISSUED------------------------------------------- ---------------------- ------------------ DATE-------- --------- -------------------------------------- Alterations and/or recommendations:;�- ------ - ----- 6t -------�-2n `-- ---------- --------------- ----------------------- 1y' /--( �,c r �_ '` Pte``--------- ------------------------------------ �- FINAL INSPECTION BY:....... •- '�c`' / l ------- Date - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton Ave. 300 West Oak Street i 24 Sycamore Street 205 West 4th Street stocktan,California Lad!,California Manteca,California Tracy,California E5 9 REVISEp 8-S9 pM 3-163