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. . APP�t.: I f ATION FOR SANITATION PERMPermit No. . .... . ......... . .. ........ .. .._�?... .___... ) - -------------------------------------- ------- .- (Complete in Duplicate) /X Date Issued _._.._.....TT._r''_ ..rr•.f .. ---------------------- This Permit Expires 1 Year From. Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct andylst Ilk herenescribed. This application is made in compliance with County Ordinance No. 549. / JOB ADDRESS AND LO ATION------ ► '/I� R+t+_... o.Kt�a ; Y► li..l J 1� Owner's Name----------------------- - --YQ l �`-f` r%�-'... Phone p�. .... ---`I.� ----- -R----- --- ` 1 . - --------------------------------------- Contractor's Name..............4u�- _�-��_w��{-._ ___..._.._ �J_�ll Phone Installation will serve: Residence ❑ Apartment House ❑ Commer eal [$Trailer Court ❑ Motel ❑ Other E]Number of living units: .--.-.-- Number of bedrooms ... Number of baths ........ Lot size --------He 0.... Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 5 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe N--*'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 felt.) , N� Septic k: Distance from nearest w I..:�(ljjfVistan rom if ution��. 1�...Materia ._.C�.'(- .!_..... No. of compartp� woo �ments.... .......i---_Size... .. . ....... ..... ...Liquid dfpth-----*. ....../....Capacity.--I DisposalField: 'Distance from nearest well-01ftDistance from foundation..1[!./^�. -.AQ,jV%,-Distance to nearest lot I�e_.�.�V1.t._y�, , Number of lines___._..._...... ........... . .Length of each line.__.__.�.817.�..._ .....Width of french... ._�-----------.._ .. Type of filter material_ re -L�Depth of filter material....... .q.._......Total length.................1OQ______._._.._.. Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to,nearest lot line--------........ ❑ Number of pits......................Lining material-----------------.-----Size: Diameter.......................Depth----------....._._............... Cesspool: Distance from nearest well.................Distance frorri, foundation....................Lining material...... -------..------ ❑ Size: Diameter- -----------------------------------Depth-----------------------•---•----- . ----------------Liquid Capacity. ---- ---------------------gals. Privy: Distance from nearest well.................----------------------------------Distance from nearest building--------------------.---._-------.---..... ❑ Distance to nearest lot line------------------------------f----------------- ------------------------------------------- ------- ----------- -------------------- - ITI Remodeling and/or repairing (describe):----L/.. /_......:._ > CrL_.___.__l'�! __r0_ _t.__.._.. //.!�/� --------------- ----------------------------• -------------- •--------------------•---------------•----••---.--------------•----•-----------••------ ---------------------------------.....---------- -------.... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State;Ia/wland rules and reg lationso f the San Joaquin Local Health District. 0 (Signed ---------- Owner and/or Contractor BY�-------------------------------------------------------------------;.._•. - (Title) ..-.. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 10 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --•----------- -- ---------------- ---------------------------------•-•• ••- ••-. . ..._.. ATE---------I. `- REVIEWEDBY------------------ ------------ ..................... ...... ..... --------- ----------------- ------ ------ DATE. ------------------------------ -------------------------- BUILDING PERMIT ISSUED.................. ------ ` 1 p DATE.---------- - --------------- Alterations ---------- - Alterations and/or recommendations:...... . .. ..... ......... ........ .............. •--- - ------------- (% ......� -- ----..........-e ------------ ....._... ......------•------------ ......................................................... --- l ... ------------------------------------------ --------------------•- ---- . --- -------------- y-... --- - --.. .---- ------ 4,Ce CJ L FINALINSPECTION BY:................................................................ Date........................................................................ ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 121•59 3M 3--63 F.P.CO.