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NOROFFICE USE: i { _ ------------------------ ------------------------------- f,. APPLICATION FOR SANITATION PERMIT Permit No. i s� ------------------ � S J --- (Complete in Duplicate) -/-/I A, t �- .� �' =t E_ This Permit;; tris i'(ear From Date-Issued Date Issued _______._-�_,_:______ 3Me. `f -OS Application is hereby made to the San Joaquin Local Health District'fo�a permifi to construc+ and install the work herein described. This application is made in compliance with with County Ordinance';No? 549. �� L ? �SCAL�It� JOB ADDRESS NR OC TR-------nN-rn Ff-:--- ---- -=I --------- ------ C Owne`r's Name------- - - QL ----------- ------ ------ '----------------- -- Phone----------- --------------------- Address----------1-61 ---------- -•--• --- Address----------1-61 ------- -.A MF—. ;.- ---------------------------------------•--•---•-----.. Contractor's Name_1,0-1>0.. P -E- _.._15 �Rtl Installation will serve: Residence�8' Apart men k Phone________________________________._ g•. I + �° t Hous Com"m1 rcial ❑ TrailerCourt ❑ Motel ❑ _Other ❑ Number of living unitsy-_J._---rNumber df bedrooms- ----- Number of batt sIS fi size _ 5_--_x ----TJ--------------- Water Supply: Publics stem I � � -- r� y ❑ Community system ❑ Private J'[.Y Depth to Water Table�'.__�f. Character of soil to a depth of 3 feet: Sand FT-lGtavel ❑ Sa'ndy Loam ❑ Clay[Laafn Clay ❑ Adobe Ej Hardpan ❑ Previous Application Made: {If yes date----------------- --1 No New Construc#ion:I ❑ FHA/VA: I I des No Yeslo ❑ i TYPEOF INSTALLATION AND SPECIFICATIONS: (No septic +ank'or cesspool permi+ted if public sewer is available within 200 f JeE p Se tic T�rlk: Distance from-nearest well_.--,,7e.a Distance from foundation I+ _Material No. of compartments---- :-------- Size Y-A (jVx---5-Liqul 1deptn`--_ -:°; Capacity---/ ---_ Disposal Field: Distance from nearest well �Q...Distance from foundation r �_ rQ__.. .Distance to nearest lot line__..___��___-___ Number:of. lines.......... _ -- Length'of,each,drr�e'• p ---1Nidth of french__2�--��------------------- Type ------------- Type of.filter n-iaterial_�- o2r-j<-'�Depfh,Xf Pilfer �rlaterial'��al:-__�;:-_Total length-_--16-a-.--. .- rt # r 45eepege,Pit: Distance to nearest Well------------ ------- Distance from foundation_________ _______bistance to nearest lot line-------- -------- Number of pits _ - .------•"Lining material---� ;- ------`----.$ize: Diameter------------- - ----- Depth --------- --- .1` k , -------- Cesspool: ;zea Dia ter_n#avast well - Ddistance;fcoin foundation--_ - Liquird Cateaci# ------------------------ .-gals {' p . Capacity - Privy: Distahce�from nearesf wellDistance from nearest building�. g ---------- ❑ Distance .to nearest lot line-.---. -----------I------------------------- •- ------------------- -:-------- -------------- and/or repairing (describe):- - ----- - - ---------------- Remodeling -------------- -------------- . - ---- -------------- •----------•------•-- -- --------- ---------------- -_ ----_- ________ ______ A _ , . -. -_ Y mow._ - ---------------------------------------------------____________________..I------------------------ ____- __.____. _ --------- _ -------------------- I hereby certify +ha+ I have prepared this ap hcation and that the work will be done in accordance with San Joaquin County ordinances, S+at ws!and ules and regulati of + San Joaquin Ld�cal Health District. - [Signed)_.- -- --------------------------- --- -- --- - ---- -- --- - -[ - -- (Owner and/or Contractor) - $Y -------------------------------- ----- --------- ------- _---------------------- (Plot . „ pl�r showing size�,of to+, Iota+ian:of system in relation to wells, buildings, etc., can be placed on reverse side).. . •” 7 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..-_. T 0-------- 1 - �. -- --'-- - --------------------------•- 5----------------- - DATE------ REVIEWED BY =---- --------------------- DATE---------- BUILDINGPERMIT ISSUED----------------t------------------------------------------------------------------ ------------------ DATE- �•------------------------------- - -------------•------ Alterations and/or recommendations:'.--_ - F. - u.F�► sA. rA -- -TIR o------------------ ,.._ .... . . - - -------------•------------------- �=- ------------- ------------------------------- -,r _ ..... _ ..,...,�. .. ..._ .� t � --------------------------------------------------------- ------ --- ----- ---------=-------------- •------------------------ ---- r r-i - � _____________ , _ FINAL INSPECTI :.--- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-•63 F.F-.CD.