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•rUtt UMU: USE; �/f A =--••-- •--� ................._................................... •--•-•.. .................•---..--__- APPLICATION FOR SANITATION PERMIT Permit No. ------------------_-------------------------....... .... (Complete in Duplicate) ........... ... • . . This Permit Expires 1 Year From Date Issued Date Issued ( Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de rbl, This application is made in compliance with County Ordinance N 49. �Q9oo °o 0 o. - - JOB ADDRESS AN LOgATI0 Owner's Name".. -* ............ .. - ........ . .......... Y Address ... �.. .d '� ...... '.......- -......................... Ph ��,,� 1 one. Contractor's Name--- o ' - r: c� - --... _..!._ ....._..._.._... -...-- ._.S - -�.,.. Installation will serve: Residence ❑ Apar _ent H Phone__............._............ Apartment House ❑,,'Commercial [ITrailer Court Motel Other t ❑ ❑ Number of living units: .... Number of bedtooms,....._z.Number of baths �/ _ �/ r- Lot sire .._.,E/��!l.a�,e+-1._ . Water Supply: Public system [] Cam_ muni s stem ��' • f tY y _❑.-,vats p�Depth afar Table ------- ft. Character of soil to a depth of 3 feet: SSnd(3'-Gravel ❑ Sandy Loam Clay Lpam 0- Clay]]f Adobe❑ Hardpan'❑ Previous Application Made: (if yes,d�,e.<�\,-__._.-..I No ❑ New Construction: Yes ❑ No,❑A.•PHA/VA: Yes ❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4, •_ i Septic Tank: Distance from nearest well.................Distance from foundation............:..._..Material........._......El No. of compartments....-- - .....4........_.....__..__...._ _Size............................--......---Liquid � depth.--•-...................Capacity.------ Disield: Distance from nearest well..7,Q-_,Distance from foundation..../ ........Distance to nearest lot line...r....... Pr i Number of lines........... .. Length of each line....../.A.D.._�... ..Width of trench.....2 Type of Z............. filter meteria._..e.l./. i.,..Depth of filter material.......11..07-Totel length.:......�._Gt:GL................• Seepage Pit: Distance to nearest well--.-._.-----_..:....Distance from foundation..__.-...._._..._.Distance to nearest lot line............... ❑ Number of pi+s--------------........Lining material..............---------Size: Diameter........................Depth ................-- ........ j Cesspool: Distance from nearest well.................Distance from foundation.................._.Lining materiel -- ❑ Size: Diameter-----".... ..:...................Depth...................................... ..........Liquid Capacity- gels. Privy: Distance.from nearest well._ ...___..Distance from nearest building ... �n ( g -- ❑ Distance to nearest lot line.............. _---___._•_ "".. Remodeling and/or repairing (describe):_ _. __.. _.•• a. v - _.._. .._. ---- ------ ---------- . .._...,.._.............._.. .................. .............. --- - i_.................:. I hereby certify that I have prepared this application and that the work will be done in accordance with S'en Joaquin County ordinances, Sfate , and rules and regulations of the San Joaquin Local Health District. (Signed)------ ...... . .�-------......... -. .. .......... - -. ............. . 49wneltia By:------- ..... _..............-....................(rifle).---- ..... - --- -nd/or:Contractor) (Plot plan, showing size of lot, location of system in relation o wells, buildings,.efc., can be placed on reverse side).-!`� , FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY.... - DATE .6.5 . REVIEWED BY.... ................... •-- .......................... ----.._...._...--_..... - - - DATE....... -BUILDING PERMIT ISSUED.............---•--....--•--•-•-••-•-----------•---------••--- - , .........------._.. _....................._ DATE..................................end/or recommendations: ••• ........ ................................. - - ............. - .........................................-............................................................,..._............. . FINAL INSPECTION BY: . w^' ---.+-- _ I SAN JOAQUIN,LOCA HEALTH D STRICTr 1601 E.Maselton Ave. 300 West Oak Straer 124 STwman strtrot 205 Wg19Nt$avor Blackfan,California Lodi,California Manteca,California Tracy,California f8 a RN,BCD B-159 ]M 3-'63 r.P.0 O. _�,