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FOR OFFICE USE: s APPLICATION FOR SANITATION PERMIT Permit No. -------- --- `' (Complete in Duplicate) Date Issued - Jf ------------------- --__.__-.-__..__.._----'`.___z'". 1' 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 LOCATION______ -;�`�6.f. ��r�-..J ___.-�_'_ .t1 - --- ?`•--- � Owner's Name ' = 1 Grl c t---- Phone. =----------------------------------- ...-------- ----------------------------- Address--------------- 1 7a-)- ------- Contractor's -•--- � -✓... L Contractor's Name------------- 771 11 --•------------------•-•--------------•-•----------------•----------------•-------:_.... Phone-------------=-_ ------•-- Installation will serve: Res'id�nce •partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: .:___ Number of bedrooms _. __ Number of baths _Z. Lot size ____. �4� ______________________'______ Water Supply: Public system ❑ Community system ❑ Private [&-,;'l epth to Water Table ft. r 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel (] "Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U]-'gardpan ❑ 11'Pre`vious.Application Made:- {If yes,date .._T__--.,-_-___.) No VNew Construction: Yes No ❑ FHA/VA: Yes ❑ No ©r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t . Septic 19-1 Ta Distance from nearest well___�4_______Distance frorn foundation Material___L'_ __f�_r- - --f ---_---:--- No. of compartments_______ -.__--_--___Size____ _ TJ-._--Liquid dept' ---Capacity----- ------- Disposal Field: Distance from nearest well--.50---_____.Distance from found�on__ �__-__-___.Distance to nearest lot Lid Number of lines-------.-_�__, ._____ ___Length of each lln�.�-___ __ _______ .___.Width of trench.____.- __ _ ___-._______ Type of filter of filter material_____ld__f'--__-.Total length_...--- ______________---_ p F _ ___-. _--.-_Distance from foundation__/�._�..____-.Distance to nearest lot ------------------ See Distance of nearest L9 material_-_ tL ___.Size: Diameter___ _ `_...___.Depth____ .5:�_____-_-__--_ P R Cesspool: Distanc6 from nearest well________________Distance from foundation---------------------Lining material-__-__.-___________--__________ ❑� Size: Diame#er--------------------------------------Depth----.......... ----- LiquidK�Capacity----------•-------------....gal Privy: Distance from nearest well___________________`___.--__-_-'-----------------Distance from nearest buildingr Distance to nearest lot-line--- ---------------x ----------------•----••--------------- -- Remodeling and%or repairing {describe.=--------- '['��------- C.�er_ r --------------------------------- _------------------------------- ------------------------------ --------=--------------------------•---•------------------------••-•-------------------------------•-•---- I hereby certif that l have prepared this applicati n and that the work will be Bene in accordance with San.-Joaquin County ordinances,'S+a a la and r e and"regula-tions of the'San Joaquin Local Health,D`isfrict. -- ------------------ -------------- ---------F------ ---- ------------------------ d r Contractor) Signed ---------:r.(Ow an ) -------------- Title - ' - - ---- -------------- By:_-_--------,--------------••- ---------•--------------------------- -( ) (Plot plan, showing size of lot;"I 'cat n of system in relation to we s, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY �� ------------- DATE -- ----- APPLICATION7AACCEPTED�'By_:_ __ -� �f � REVIEWEDBY-------------------------------=---------------------------------- ----------------------------.--------------------------- DATE---- ------------------------------------------ BUILDING':�PERMIT ISSUED---------------- �------•- .,---- ----------------------------------- -------.--------- ------- DATE---- ----- -- -------------- Alterations and/or•recommendations:__--_ ._ !-sz'L-t``. � _. - - ''-�^' ----- - -------------- J' ------------------- --------------------------------------- --------- ------------ --------------------------- rZ r _________________________________________________________ ----------I------------------- ----------..----------------- -___.._S_.---- ------. _-------------------------------------- _________-A-.___._._____.__-_._._____.__.-.--____.___._________ Y� - --- �.�. 4 Date-' �- - = '_' .'�.., FINAL INSPECTION- BY:�- :__ . _ --------------------- r'SAN JOAUIN'LOCAL HEALTH DISTRICT 130 SouthAmerican Street ±300 West Oak Street' 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9-9 REVISED B-59