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P 3 ' 7 .--.- - � - --G- :--- . ^- APPL«ATION FOR SANITATION PERMIT . Permit No. .-_�_-7.�-_/.0 - (Complete in Duplicate) ------------------------------------------- This Permit Expires 1'Year Froin .Date Issued Date 'Issued .._�/ _� Application is hereby made to the San Joaquin Local Healfh 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 L0�ITION�=- ---- ----- ------- -- -��: ---�-�-----•---------------------------------------------------- Owner's Names --ggf _ - - --- ----- "~ Phones_. 1 Addressc ... -- - - = Contractor's Name____._ -- - ,..=``-" '�- - one---------------------------.-.-.-.-.-.-.-.-.-.-.-.-. Installation will serve: Residence �artment House ❑. Commercial ❑ Trailer. Court Motel ❑ Other ❑ Number of living units: ___ ___: Number of bedrooms -,t2j- Number-of baths _-l.i of size _ _- .8- _--____________________ g Water Supply: Public:system .Community system ❑ private ❑ Depth to Water Table /0-pff. Character 9f soil to a depth of 3 feet: I Sand ❑ Gravel p Sandy Loam❑ Clay Loam ❑ C y'❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date----------_----------) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) c - Septic Tank: Distance from nearest well-KOR .__Distance from rfoundation-AO--__-______.Mater" L__ __________ __�-�..>^- --------- -- No. of compartments___--_______._ _ Size��_ �_Liquid depth--- �,-.----Capacity__ - -/ , v , Disposal Field: Distance from nearest well-�._. _ . ._.Distance from foundation.___ ____.__.Distance to nearest lot line________________ Number of lines-------_ -----____-- . Length of each line------�-C%t_-j----------Width of french----A_��---------------- � Type of filter material ..', _Depth of filter materia------ __,_Total length__9 p_'_______._-____________-- 00 Seepage Pit: Distance to nearest well-,_ __Distan rom oundation---- ____-__.D"st nce to nearest lot !,e -- --- -r // ��. Number of pits_:-___r___.___.______Lining material- _ ___.__.Size: Diameter-_. _ Dept h� -------- Cesspool: Distance from nearest well----------------- from oundation--.,._-___---___-__.Lining material__--.._______._____._ Z ❑ Size: Diameter.---'------- ---------------Depth------------------------------" - ----------------Liquid Capacity --gals. Privy: Distance from nearest well ______________----------------------------------Distance from nearest building.._-___------_-_______________----___._. ❑ Distance to nearest lot line------------------- - Remodeling and/or repairing (descL6)---------------------------------------------------------------------- q -----------------•-••----------------- ----------------•------------------------------•---=--------------------- ---------------------------•------------------------------------------•-------------' __ _____--------------------3____------------------------------------------------------------------------- --..•-----------------------------------------•-----------------__.._._':-._____-- .eF I hereby certify__________that I have prepared this application and that the work will a done,in accordance with San Joaquin County .fir ordinances, St to la s, and rules arid regulations oJeS a al Hee h District. iCy �(Signed} �� t G 4+r`� n1 --------------- -attd�{erContractor] BY•--------------------------------------------- ---------------------- - ----------- --(Title)---------.:.,------- --- `= -------- -- - - ---------- r (Plot plan, showing size of lot, location of system inwells, buildings, c., can be placed on reverse side}. _t r. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ / [ -------- --------- -------- DATE-------- f REVIEWED BY - V--------------------------------•---- DATE BUILDING PERMIT ISSUED------------------------- -- - DATE-----------------------------;-----------------------� — —�-Z��- r Alterations and/or recommendations:"__--__- ---f_____.- ------•---- r -? .' =, l --- --------- ------------------------------------------------------------------------•--•------------- ,: - - -------------------------------------------------------- ------------------- r� BY: Date--- --FINAL INSPECTION ... a ------------------------------------- SS N JOAQUIN LOCAL HEALTH DISTRICT ti 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REV15 Efl 6-59 3M 3-'63 F.P.0 O. 'I .1