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,,F7R FFICE USE: r_ r Ira ` --------------------------------------------------------- �/ APPLICATION FOR SANITATION PERMIT Permit No. _1... .. �p.. (Complete in Duplicate) . ------------------------------------------------___..--- This Permit Expires 1 Year From Date Issued Date Issued .______ __-�'-4�6 7 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 Cifoinance No. 549. JOB ADDRESS AND LOCATION__^- -------------- ,------------- _______ f_________ Owner's Name if^�'T�l?..�/.! •-----��1 e------ - Phone ---------------------------------------------------------- Address 3 e -7-� m - - ' Contractor's Name�Q----!q•q---- ----- - -------- --------- Phone... - -t----- --- --�---------------------------------- Installation will serve: Residence R 'A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __ �4� JPO �___ Number of bedrooms ___ Number of baths _�____ Lot size ______________ _____________________________________________ Water Supply: Public system ❑ Community syst-m ❑ Private ❑ Depth to Water Table 40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam E] Clay E] Adobe [}-"hardpan E] Application Made: (If yes,date--------------------) No jKNew Construction: Yes �o ❑ FHA/VA: Yes ❑ No Pq�`` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well-►= Q-1_.Distance from foundation__Via__r____-Material__'_-- . No. of compartments________._ Size---- _____Liquid depth____--l----------------Capacity--- v_�,,,� Disposal Field: Distance from nearest well---4��-t.._Distance from foundationzp--------------Distance to nearest lot line_,``_______. Number of lines------��,�_------�__.______.______Length of each line_-7� _/----------.---Width of trench--a2 '_yf---------------- Type of filter materia l___Jl-_a.4_�------_Depth of filter material-_f_e`------------Total length------.�s� o__________________ lor — I W Seep well-lo? Pit: Distance to nearest welll __________Distance from foundation_�C_ _ _--_._____.Distance to nearest lot line__ -j--------- Number of pits___.__�':-_�____Lining material__ .4�__.__.Size: Diameter_-�3...-_ --_ Depth Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material----- 171 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. V r� Privy: Distance from nearest well-------------------------------------- ----------Distance from nearest building______________________________.__._.___-- (� ❑ Distance to nearest lot line--------- ------s------------------------------------------------------ ---------------------------------------------------------------------- +� Remodeling and/or repairing (describe __________________________ I 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 rules an regulations of the San Joaquin Local Health District. (Signed) ' Owner and/or Contractor --------------------- By:-------------------- ---------------------------- -------------------------------------------------------------------(Title)-----C-7.-W----�/L--------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____. V ��'---------------------------- --------- tom' DATE REVIEWEDBY------- ------------------------------------ ------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------- Altera ions and/or recommendations:__________________________________________..___ - -_------ - `------------------------------- -------------------•------------•--•---------------•------------------------- ---....------------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------�-�---------------------------------- FINAL INSPECTION BY:-------- ..... rJOA -----•------------- -- Date--------- SQUIN 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 RCViSEO 8-59 3M 3-'63 F.P.rq.