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FOR USE: ----------------------- - ----------------- ---- - -------_--- -_-0________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ..ls .. ------------ - ------ -- --------------- ---- -------- (Complete in Duplicate) G- , --------------------- This Permit Expires 1 Year From Date Issued Date Issued ..-d/.S6 ---�-- --- - - ------ 225--a / - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de rimed. This application-is made incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIO : ��s-a .e Y----- O�-- } ------------ d Owner's Name-- ---n-------1j, --- ARA_6H..[-----• - ----- ----- --------- - -------------------- -- Phone--------------- -------------------- Address ' v' 0 ---------7------------= ._ 1 Contractors Name-.. ----------------------------- Phone---I --------------------- Installation will serve\`Residence �partment House+❑ Commercial ❑ TrsilerCourt E] Motel ❑/Other E]X i Number of living units: ----I- Number of bedrooms --41- Number of baths ---/---'Lot size __ l'P �--------.-.-___----------------- Water Supply: Public system ❑ Community system ❑ Private Be'pth to Water Table J.4--it/ Character of soil to a'depth of 3 feet: Sand ©ravel ❑ Sandy Loam ❑ Clay Loam.❑ CCllay❑ Adobe ❑ Hardpan E] Previous Application Made: (If yes,date--------------------)-No [rNew Construction: Yes Q]/, 20 FHA/VA: Yes !o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Septic TA& Distance from nearest well ................Distance .fromfoundation......._.....-......Mate ial -----------------.-----.---.---.-.-- ------ No. of compartments--__----- . ........Size-_- � ..Liquid depth--.-- ; ------Capacity-_--f-----p Disposal Field: Distance from nearest well-_5P-----Distance from found istance to nearest lot line----.. �.. ; Number of lines--.-__._ ... Length of each linea`.. _.Width of trench..-... ................. �` Type of filter material-. -.-.--...Depth of filter material-...--19'..._Total length------1-3 ----------------- ` ll Seepage Pit: Distance to nearest well....t57 ..............Distance from foundation__7 -----------Distance to nearest lot line____-___-__.. -. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------. -----------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance.from foundation---.---------------Lining material--.-------------- 10 ❑ Size: Diameter- --------------- ----- ----Depth------ ------------------- -------------- ----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------_--------------------------------------Distance from nearest,building------------------------------------------ ❑ Distance to nearest lot line- - - --- -- ------------------------------------ ••-•-------------------------------------------- ------ i f Remodeling and/or repairing (describe) _ r11rI-------- "----------------------------------- m jt ` { f - � �r. I +' I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rule and regulations of the San Joaquin Local Health District. (Signed)---------- -------------------------------- --- -------------------------------------------------------------- (Owner and/or Contractor) By,: --- ----- (Title)--. Ti#le (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). It FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY f :- ------------------ DATE - - � �� REVIEWED BY---- ---------------------------------- -- ----------- �----------------------- DATE------------------•---------------- -- -- - ----- - - ----------------------- BUILDING PERMIT ISSUED--- ---------------------- ---------------•------------------------------------------------------- DATE.------------------------------------------------------- -- Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------•-------------•------------------------------- --------------------------------------- -I-------------------------------------------------------------------------------------------=--------- ---•------------------------------------------------------------------------- v FINAL INSP ION B - a � Date---.------- p -- !,- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 '71M 3-'63 F.P.CO.