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FOR FFICE USE: '7 C-------- ----- ` s --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------- ----------:------- (Complete in Duplicate) Date Issued __G�- 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 LOCA'TIION--------�-�C�---/ f � 1/-� 1�`"G/ /� -------------------------- Owner's Name------- --------•#- Z47—i-------•-- _.l.iY��"rl"" � 1: -------------- Address ------------ Phone Address---------------------•------------------- 1w------------ 17_TL( ------- - ...---------••---------------•----------•- Contractor's Name------------------------ x/11 Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _;;�=ity of bedrooms,._ --Number of baths Lo size ft. g Q Water Supply: Public system system []-.�Fnvate El Depth to Water Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe ardpan ❑ Previous Application Made: (if yes,date--------------------}Y No New Construction: Yes ❑ NoA/VA: Yes ❑ No I r I TYPE OF INSTALLATION AND SPECIFICATIONS: ., (No septic tank or cesspool permitted if public sewer.,is available within 200 feet.) Septic Tank: Distance from nearest wel4______ _______Distance from foundation__.--"-"____-___-_ Material---------- ------------------------ No. of compartments--------------------------Size-f---•---`------------------ Liquid. depth-------------------------Capacity ..-. -Distance from founclation�°*__4K__�,-.Distance to nearest lot line_---s-_-�_. Disposal Fi Distance from nearest well --.---------Distance �- - p r f _ Number of lines----------------�--�----" _C Length of etch l�ne�_.�.� ._--"-----_-Width of trench ----- ---- ------------------- 17 - -------------- l -ellih�✓j �1�fype of filter material____.-_�.�� --- epth of filter,mafienal.______________.___Total length____ --_ Seepage P' Distance to nearest well__.-��__Distance , orn, ovndation_-F��____.-_.Distance to nearest lot line_________________ W ® umber of ;ts---- ------Linin materialL_�O.G.fC_-----Size: D'iameter-- 6---------------Depth-- v C.:esspool: Distance from nearest well-----------------Distance from 'foundation--------------------.Lining material__.___-__..._--_----._"-__-____---__ [] Size: Diameter--------------------------------------Depth----------- ---------------- - Liquid Capacity----------------------------gals. -------------------------------------------- ---Distance from nearest building----------------------------------------- Privy: Distance from nearest well--------------- ❑ Distance to nearest lot line = - -- ----------------------- ! Remodeling and/or repairing (describe):---- ------- -fir --------- --•----------------------------------------------------------------------------------------------------------- - •---------------------------------- 1 ----------------------------------- - --------------------------------------- ----------- ------•--------•--------- - -' ---------•---------------------------------------------------------------- ------------------------------------------------------------------------------------ ----------------------- ............................................................... --------- ------------ 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 r d regulati f the San Joaquin Loyal Health?District. .r'f [Signed} --- -- ------ - ------------------ ------------------ �------ ---(Owner and/or Contractor) %c/ ------- - ----------------------------(Titl -- By:------------------- - B1 (Plot plan, showing size of lot, oca+. n of system in relation to wells, buildings, etc., can be placed on reverse side}. s r j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---- -- _ �v'S...:..............---------------------- DATE---------- -------------------------- DAT ------------------------------------ REVIEWED BY----------------------------------- -- ----------------- ---- -- ------- ------ - ----- -- - -----------------------•--- •- -------------------- BUILDING PERMIT ISSUED--------------------------------- r ! �y'` E c �/ _ .fa =d - � Alterations and/or recommendations:.....:.. .. .. ... -- 7 ------------------- ---------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ------------------------------------------------------------ ------------- f ," FINAL INSPECTION BY:. " - - - Date U!.1?_5 �2L� SAN JOAQUIN LOCAL HEALTH'DISTRICT rr-k, 1401 E.Hazelton Ave. } ,.-yl 300 West Oak Street .' '124 Sycamore Street 205 West 9th'Street 5tocklon,California Lod:California Manteca,California Tracy,California E5 9 RFVl5EO B-59 3M 3-'63 F.F.CC.