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FO OFFICE USE: C� r --------_?.s _- ------ APPLICATION FOR SANITATION PERMIT Permit No- _--------------------- e ._r ,-7-31-------- (Complete in Duplicate) Date Issued __ _+y _��'.`f . . 13 ___.__. 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 LO ATI N____�- _ ......"-"- . _ r. G�- ---------------------------------- Owner's Name--------" --7 "/---- ,�j� Address �� --------------------------------------------------•---•----------------- ------------- - Contractor's Name"--"-"/esidence ----- =------------------------------------------------ Phone..Installation will serve: Q---A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___)___ Number of bedrooms __.;-)'-_Number of baths __/___ Lot size „5 __X__ ,�'J________-- --_ Water Supply: Public systemommuni+y system [] Private ❑ Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand [❑ Gravel E] Sandy Loam ❑ Clay Loam [] Clay ❑ 'Adobe ardpan ❑ Previous Application Made: (If yes;date--------------- ---I No'6 ew Construction: Yes ❑ No HA/VA: Yes ❑ No �— TYPE OF INSTALLATION AND SPECIFICATIONS: a (No septic tank or tcesspool-perriiifted-if"Ttblic sewer'is available`w Wn-200-feet.) Sepfic Tank: Distance from nearest well-----------------Distance from foundation-----------i A.Ma+eriaL___._______._.__________..______..__.-_____-_. ❑ I No. of compartments------ -------- ---- -----Size--------------------------------Liquid depth �', ": Capacity--•-------------------- Dis osal Field- Distance from nearest well_________________Distance from foundation--------------------Distance,to nearest lot line-__-____-_______ / 1✓ Number of lines------------------------------ ----Length of each line-----------------------------.Width of`trench-------_-----:------------------_-- -Type of-filter-material---_----------------------Depth'ofljilter ) material-----------------------Total length__ -----------""--""""-��--- SeepagDistance to nearest well fr m foundation--z-------------- to nearest of line_ ______________ tM [t Number ofkpits._____1___________Lining material__._ VC,, _.Size: Diameter ..`C_.-____Dep+ //C1c�------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____________---_________.__._________. ❑ Size: D`iameter--------------------------- - -------Depth----••------------------------------------- --------Liquid Capacity----------------------------gals. , Privy: Distance from nearest well_______________ ___________`:.____---._.__----Distance from nearest building---------------------------------------_- ❑ Distance to nearest lot line �r�r -(rde'scribe) ? c )l.---------- �------------- l _ -- ,------------------------------------------------------------------------- -- _____________Remodeling and/or repairing f t ; } '`` -------------------- r ` _.__ ____________v_.__-_ __.__.____-__--_.____-_-_________________________________________________--_---____-____________________._..__._..._..-._____-_________________________�_- ___ _ ____.________.___ , - - - y4 __________--------------------------------- I hereby certify that I have prepared this application and that the work will be done in-w�ordance with San Joaquin County ordinances, Stat a and r d regulations of the San Joaquin Local Health District. (Signed)------------ 1;- ------ :C 4-----j --- ------------------ ------------------------------------------=----------------- --- ---(Owner and/or Contractor) B ---------------(Title)"" ; By: - -- ---- I �--- ---- ; ;.-- (Plot plan, showing size o t, location of system in relation to wefts, buildings, etc., can be placed on reverse side). FOR_DEPART,MEN7 USE ONLY . , APPLICATION ACCEPTED BY--------- ------- ------ ------------------ DATE---- 2=-FR -""----------------- REVIEWEDBY------------------------------------ ------- --------------------------------- ------- -------------------------------------- DATE------------------- ------ ------------------- BUILDING PERMIT ISSUED---------------------------------- ----- = ------ -------- DATE--------:---- Alterations and/or rec endation __ rt tt �L_�I _._ _ �_31�t! -- --�C_ & f ary �.•/G' /•f��-f�fGl ,/ -G4.�ti- r ----------------------- �•_W � �__. *�f'- __.�_� _.�f �F _ u /! s------------------------------------------------ �. 3- y' � . , ----------------------- --------------------- ----- { .-- -�.c�c- --Grn_e ¢u_ .a <--- - -- - r ' ----------------------------- - l INAL INSPECTION $Y:. ----=r---• ----------- - Date- - SPI --------------------------------------------- f 5 S;aAN JO QUIN LOCAL HEALTH .DISTRICT 1601 E.Ho:elton Ave. 300'West Oak Street 124'Sycomore-Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California JJff ES % REVISED H-59 3M 3-'63 F.P.CD. , 4