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FOR OFFICE USE: JI------------ -- Permit No. .�f ._ - ------------------------------------ _ APPLICATION FOR SANITATION PERMIT if ------------------------------- - (Complete in Duplicate) ------- ---- ------ � Date Issued �� "___-".-_-__-- ------- _- This Permit Expires 1 Year From Date Issued g -3 p 0 -, I: Application is hereby made to the'San Joaquin Local Health District for a permit to construefi �,d. a e w rl erei� described. w This application is made in compliance with County Ordinance No. 549. F ;235`l 7 s' ,. 1 ,[� � . ._. f. " ------------- ----------- �;� JOB ADDRESS AND LOCATION----- % ! -4 -- --/ Owner's Name /L -- --- Phone. Address_ll.- - ` " ••. _3 ---��/f----- - ?,,..-------------------"--"-"--------------"--------------•--"-------•-------------•-•------..__-. Contractor's Name---------- -•- - Phone.--•------------------------------- Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Traile{ Court ❑ Mot l Other ❑ Number of living units: ---I--_ Number of bedrooms _ _. Number of baths _L___ Lot size -----------�l-----------•"------•------------------------ Water Supply: Public system ElCommunity system ElPrivate Depth to Water Table " ft, Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date----------- ------) No New Construction: Yes No ❑ FHA/VA: Yes F1 No TYPE.OF INSTALLATION-AND.rSPECIFIC-ATIONS:- (No septic tank or cesspool permitted if public s' er is available within 200 feet.) _- C_,Dista� frm f do _ _.Sep Tank: Distance from nearest well ! � 4ate-r_i.a_l_ C_-_a__-ac-it- -1�..... --!, Sie _,_afLpuiept ____.No. of compartments- .�..... .....P.r Dis osal Field: Distance fromtnearest eIL _ -_-Distance fro ft _. - Distance to nearest lot li e� � p Number of lines g l T ._.Width of trench 1 ---...._ ti - -Length R_eac�i m �- Type of filter material--_j_[-�e.�.Depth of filter material-__ -f------Total length_-_.__-�_��_________________"-. � 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 from 'foundation------------- ------Lining material_.-_--_-_-_.-----_.-_--_-__-__---_-. ❑ Size: Diameter--------------------------------------Depth_------------------------------------ -------------Liquid Capacity-.--------------------------gals., a_� ._ .. ,�,. ------------------------------.., -"Distance fromm neares+"buildin Privy: Distance.from nearest well __._. --- -- - - ------ - ------------- ❑ Distance to nearest lot line------- ---- --------------------------------------------------------------------------------------------- Remodeling and/or re airin describe _------'- --l--F�---------- "' A �" '' `�"^ ____________________"___ 9 / p g (describe)::---- rW - �.• r -----------------------------•------------------------------------------------•----------------------------- - i --------------------------- --------------------------------------------------------------------------------•--------- ___ ___ _` --------------------•---------------------------- I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Signed 7` >Q� ;'JET^ ?�`z' !L ---------- ---------------------------•------------------------------------------------(Owner and/or Contactor) ` By:_------------------------------------------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - a FOR DEPARTMENT USE ONLY I _ APPLICATION ACCEPTED BY--=------------------------ -------------- E ----.------------------------=------ =---------- -.... Br' �DAATTE J(� ----- 770-- REVIEWEDBY------------------------------------ ---------•-------- ---------------------------------------- -- "� BUILDINGPERMIT ISSUED--------------------------------------------------------------- • ATE--- ---------------- -------------------------------------------------- Alterations and/or recommendations:------------------------------------'''---------- -----•----------------- ------•---------------------------- i •----- ----'---------------------------------- ---------------------------------------- -------------------------------------------- �,. --"-------------- -----------------------------..." _. ---------------------------------------------- .. ---------------------------------- --------------------------- --- ---- FINAL INSPECTION BY:.----- ` f `------- Date.--------C -1------ ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California y Manteca,California Tracy,California N, — E5 9 REVISED 8-59 3M 3-•53 F-p.pp. •