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-------------------- --------------------------- 11PI(PY- ------------------ -- A"PLICATION FOR SANITATION PER' Permit No. -•---------•----------------aole-- (Complete in Duplicate) Com / r - ( P Date Issued . .........--------------------------- -_.--_ --- 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_c�✓T/V1 _Y �.ra Ta '� �°� L`'`�°x G11�'"'�' TdT�aw -P� Owner's Name-- -------- h ,Z Phone~�' }' ��4------- Address------IJ7,6 1Y ----------- Contractor's Name------ _ Phone__�114_.y-zf'2�r7_G Installation will serve: Residence [ice Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __L_._ Number of bedrooms _-,Z_. Number of baths ---I... Lot size ____ ------ -_______________ ,,Water Supply: Public system ❑ Community system ❑ Private P-- Depth to Water Table _8fft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 21'Hardpan ❑ Previous Application Made: (If yes,date._.-_.............) No [g- New Construction: Yes ❑ No (�j- FHA/VA: Yes ❑ No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) w Septic Tank: Distance from nearest well _-__..---------Distance from foundation----.---------------Material----------------------------_______._-_--_--_. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal ------------- ---- --Disposal Field: Distance from nearest well...'.If.._!d____Distance from foundation___-_- ---------Distance to nearest lot line___.._.__..... [T� Number of lines-------------I-____._-___.--- ----Length of each line-----_----A-Q_____-____.Width of trench--------3-_,*-------------------- Type of filter material___RDS-___ .. If yp '____.__Depth of filter material---- length----------b__O__.------------------- Seepage Pit: Distance to nearest well----�Q.'J__�____Distance from foundation----/111?--------..Distance to nearest lot line---- ------_.._ PT Number of pits -----------Lining material------doc-A--- Size: Diameter---J,_, - Depth ...-z<f_-_-_.____--___. Cesspool: Distance from nearest well_________________Distance from foundation.------------------- material_-_._____.________-..___-._.__ ❑ Size: Diameter- ---------- -------------------------Depth------------------- --------------------------------Liquid Capacity---- -----------------------gals. C Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________________________________________ G ❑ Distance to nearest lot line------------------------------------------------•-----------------•---------------------------- -------------------------------------------- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------•-------------•----•----------------•------- . ------- ------------------------------------------•------------------•-----------------------•--------------------------------------------------------•-------------------------------------------- - -- -------------------- --------------------------------------------------------------------- -------------------------•--------•------•-------------=--------------------------------------•------------------------- _--- ------------------- ------------------------•------- --------------------------------------------------------------•--------------------------------------------------•--- •--•----------------------------- 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, an rules and regulations of the San Joaquin Local Health District. (Signed)- --------------- ------ - -------- (Owner and/or Contractor) By:----------------' - ---------------------------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can b6 placed on reverse side). FOR DEPARTME T USE ONLY APPLICATION ACCEPTED BY-- -------- ----------------------------- - DATE �_ -G q REVIEWEDBY --- -------- ----------------- ---------------------------..---------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------•---------•----- --------------------:.--------•------•--------------------•---- DATE-----I------------------------------------------------------- Alterations and/or rec temendations__________________.._..-.._.____. . -----®,I<. -- 17----- -- --------------------•-------------------------------------------------------------------------------------------------------- ---- --- - -- - --------- --------------------------- ----------------------------------•------------------------------•--------••----------------------- --•------•---------•----------•----------------••.... -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:......... -,:e_ __' p _ - Date.----------- _______._J SAN JOAQUIN 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 REVISED 6-59 3M 3-'63 F.P.CD.