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FOR OFFICE USE: ---------------------------------------- -------------- - --------------------------------------------------- �.�y APPLICATION FOR SANITATION PERMIT Permit No. .. .......__..._.... _. _ 3 Com lete_.in_Du ilcete � f � { ' 3. This Permit Expires 1 Year From Date Issued Date-Issued____.- _ :-QA pp Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordin nce,No. 549. Owners Name f - �ri.r_ --- V-fQ �- ��, ----- - ------- Phon- -------------- JOB ADDRESS AND LOCATION.___ ------ 1) 4 b n t Address prn'l• t -------••---------------------•----------------------------------------------------- Contractor's ---•-•-------•----------------------- Contractor's Name --- --�• ---------- -- -- ------- --------------------------------------------------------------------- Phone------------------ { Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court -❑ Motel ❑ Other ❑ Number of living units: umber of bedrooms _� _ __ Lot size .- Number of baths. / `O- -------------------- � _ _ � mmunify Wafer Supply: Public system system ❑ Private ❑ Depth to Water Table_ ft. 3 Character of soil to a de th of 3 feet: Sand t t. P {Gravel ❑ Sandy�Loam ❑ Clay Loam ❑ Clay ❑ Adobe?❑ Harden ❑ Previous Application Made: llf yes,date.............___.._) No New;Construction: YesI�❑ FHA/VA:,Yes ❑ No cf,F ...-TYPE-OF INSTALLATION AND SPECIFtATIONS: w o-se tic:#ank or cess�oo! erxriitted i# ublic-sewer-is available;withirt-200=fee#:} `� "" ' F: ___-____Distance from foun ;` ------- Septdw�o a P P -IP P ic T k: Distance from nearest well___ - Size i dationL _______________Material--. -.__-__--- _ No."of compartments_- # "-x--------Llquid depth- ------------ -- CaPa ity1_?_,*t'}O Disposal Field: Distance from nearest-well-.—__..__-__Distance from foundation-_!>5i------------Distance to nearest lot line.__ of Number filter material-- 6-C-1 Len the of each Iyine-- --------------Width of trench2- -�l------,-.-- 9 Depth fof filter rateiial_ el'"� _-.-::__-Total^-'lengfh___=____._;' Seepa Pit: Distance to'nearest well_.--__.______._______.Distance from foundation__' -,7 - __.Distance to nearest lot fine__. __{_�±?_ Number of pits..--------------------Liningrmaterial --------- ------------Size: Diameter---------------------.-.Depth.---_-------..--------- - ` { ------- Cess ool: Distance from nearest well-------------------Distance from foundation.: "° ----------Lining material-------...________.___-----1- ❑ Size: Diameter--- ` Depth i N------------Liquid Capacity--------------------------=-gals.` ! Privy: Distance from nee:est weli______________________________ t f _Distance from_nearest building___-_,__5______________ f Distance to nearest lot line---------- -- ______ f ----------•------- ----•-------------------------------------------------------------------------------- --------- Remodeling -- - ------ --------- Remodeling and/or repairing (describe):-------------------_ ---------------. - •• s ---- --------•--------------------------••------------- - - --- ---------------------------------------------------------------1 I 1 I ------------------------------- ---•----] f ----•--------------------- ••----•-- ----------------------------------- - I hereby certify that I have prepared this application and that thefwork will be done in accordance with Sari Joaquin County ordinances, State laws;and rules a reg lations o the San Joaquin Local Health District. {Signed{----------- ------ ------ ! I . [ wrier Contractor) -- - - -- ------ ----- aid/or o t - -- n r or i IL = ----- ----- - [Plot plan, showing size of lot, location of system in relation to wells, bulldings'efc.rrtan_be,.placed on reverse-side]. f t FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED By `-------------------- --------- �L_ DATE / a' - ------------ ----------REVIEWED BY------------------------------------------------ DATE -------------- BUILDING PERMIT ISSUED --------- ------------ -------------------------------------- DATE l Alterations and/or recommendations:-t--_-..______...__ __....._____._ •=: r 1 ----------------------------------------------------------------- - ------------ --------------=-------- -•----- ----------------- ----------------••-------•---- ----------------------------------------.-- ---------------- ---------------------- I ----- --- ------------ l FINAL INSPECT! Y �,,,� Date------= SAN JOAQUIN LOCAL HEALTH DISTRICT I 3 1801 E.Harahan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 96 9 REVISED 0-59 314 3•-63 F,p,CO. n