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USE- -------------------- ------ _ *` - ------------------------%l�, 1�_ APPLICATION'EQR SANITATION PERMIT Permit No. .. ,0 0 6-D `� ------ --"-------- ----------------- ---------- ---------- (Complete in Duplicate) ----------------------------------- --------------------- This Permit Expires 1 Year Fr m Date Issued Date`Issued Application is..hereby made to the San Joaquin Local Hea#h District for a permit to construct and install the 'rk herein described. This application is made in compliance with County Or ' ante No. 549. JOB ADDRESS AN OCATIONICU -J � �'} �j = ` i Owner's Namey1- ----- ------- - - --- --- Phone_ Address-------••-------r .f s __ - Contractor's Name- _ •-` t o-------- ------------ ------- - --------- -- - - ------------- �. ---------- Ph e-1?-z Installation will serve: Residence Apartment Ouse ❑ Commercial ❑ Trailer Court p Motel [] Other Number of living units: --/_- Number of bedrooms Nurnber of baths _1--- Lot size ___p{�---------6 - ------- ---------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table,6e- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ . Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ E Previous Application Made: (if yes,dote--------------------) No ❑ New Construction: Yes [] No PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! S fic . - Distance from nearest well-----------------Distance from foundation-_---__--_--------.Material_---_.-.____- -_._ - - -------------------------" No. of compartments------ ---------------- Size--------------------------------Liquid depth_------------------- _. k Capacity Di�pbsaJ d::: Distance from nearest weiL_ _ Distance from foundation.---_h r_ ( Distance to nearest lot line-----of lines------ -------------- Length of each line---�-9-" ---"Width of trench-_-._ _ ' ------- Type of filter material �.r �t .--,Depth Depth of filter. material-___ _ __ Total length--__ - r Seepage Pit: Distance to nearest well - __---Distance from f undation O P Distance to nearest lot line-------- ----- ---- f Number of pits-: -----__-"--- --Lining material_�7 - - -"---Size: Diamefer-_- rJ----"-----.Depth . Cesspool: Disfance from nearest well-----------------Distance from undation--- Lining material__---_-"____________:__-_--_ ❑ I Size: Diameter .. ----------------------------Depth ----- -------- -------Liquid Capacity--------------- ------------gals, Privy: Distance from nearest well---. ---_- --" --- ----- Distance from nearest building------------- 9 ❑ Distance to neafes# lot line -------------"____-----_-___--"_.-.--_._ ---- - ---------------------- - Remodeiing and/or repairing (describe):-.- ----------- --------- --•--de -------------•------• ------ -----------------•------------ I-- � - - --- ---------- y ----- -- --- - - -- ------------ - - --- -- --- ------ - - - ----- - I here (certify that I have prepared this application and t at the work will be done in-accordance with San Joaquin County ordinance ate I and r sandy Iatio of the San J quin Loc Health District. (Signed)----------- - - 14W` - l [ -- .fi Y------- --- --- � or Contractor ! 8Y= --------------- itle) [Plot plan, showing size.of.lot, location of system in relation to wells, I dings, etc., c n be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------- ------------ - -------- REVIEWED BY !f `-- -'r l ----- -------------- ----------------------------- -- - --------- DXfE- - ----------------------- BUILDING ---- ----------- -" UILDING PERMIT ISSUED--------------- -- ------------------------------ ----- - ------- DATE------------------------------�----------------------- 4r --�-0.--�--_----.------------s--- _ _ -� L DATEAltera#ions and/or recom enda+ions:, - - -- - --4C p _ -- - ---_l _ ------ ----------- E---------- i --- -- ------- - _rF 'f- ------- tri ---------- FINAL ----- -- FINAL INSPECTION BY:-...... ---------- -- - --------------------- t- _ "_- l SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Avg. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California K5 9 REVISED U-59 3M 3•'63 F.P.L^O.