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FOR OFFICE USE: — , ------------------/F- ' ..............._------.-------_----. --.____--.---. APPLICATION FOR SANITATION PERMIT Permit No. Z7zn'-/------ ----------------------------------------------- (Complete in Duplicate) This Permit Expires I Year From Date Issued -- i --..--- -------------- ----------- ------�--- --' Date Issued --� Application is hereby made to the San Joaquin Local Health District for a permit to construct and in4all the work herein described. This applicat.iori-is.,made-in_compliance with County Ordinance No. 549. t JOB ADDRESS AND LOCATION---l2w G f Owner's Name--------��_ 10r—_7 Address-----•----•---•-----------i-----------------•---I---------------------------------------•-----•------------------------ Contractor's Name-----t----1-00,14_ __ -------//V -f---•-•----------------------------------------•------•---- ------------ Phone__'`' OKO g�� t Installation will serve: Residence . Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ OtherIlk r Number of living units: ___I-- Number of bedrooms _ -_ Number of baths __I--- Lot size -----A-C-AZ-�__________________________________ 1 - Water Supply: Public:system ' Community system ❑ Private ❑ Depth to Water Table -------- ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam .❑ Clay`vl AdobeV Hardpan ❑ Previous Application Made: (If yes,date-------- -----------) No New Construction: Yes ❑ No �K FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND.SPECIFICATIONS: (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) t Septic Tank: Distance from nearest wel!-----------------Distance from foundation_---------__.__--_-.Material.---.--____------_.-.___._______-.__-'.__-.__... ❑ Q,�e�"'I►' No. of compartments--------------------------Size-,------------------------------Liquid depth--•--------=--- ----------Capacity---•------------ ---- Disposal Field: Distance from nearest well-V%&-r.�-._Distance from foundation.-...-)-0 .Distance to nearest lot Number of linesl.--t---------------------------Length of each line----x9b------------------.Width of trench--------ex-'------------------- .Type,of filter material_$'• -AfK--_Depth of filter material-_---.j_8...........Total length---------I-fQ-_ ........... Seepage Pit; _,.- _-*Distance.to nearest well------------ --------Distance from .foundation-------------------:Distance-to nearest.lot:.line-__--- -___-_-_-- r ❑ :Number of pits-"t-- .--------------Lining material---------------------..Size: Diameter.---.-------------- ---.Depth--------- _- -------------- # k9 y J Cesspool: Distance from nearest well-----------------Distance from foundation material---- ❑ Size: Diameter._:_- ------------------ ----- Depth------------------------------ --------�`.......Liquid Opacity--------- ----=-----•----..gals. Privy: Distance from nearest well---------- __------------------------------Distance from nearest.building_._.--..-____________--_________..---..__. "r F ❑ Distanie to nearest lot.line. '-------------—-----------------------------------------------------------------------------------------•----------------------- � - � Remodeling and/orf repairing,.(describe}:F.''i9_ _`.�__.- .. JC+fsS_Tlnll`__---- ` !S-TE----------------- --------------------------------•------------ ---------•- q -=---------------------------------------------------------------------------------------------- ----•--------------------I--------I------------•------------------------------------ -- ------------------- ------------ _ x _- _ I hereby certify that-I have prepared this 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. 3 (Signed) - = '= - -----------�wner and/or Contractor) BY= ter``' ----------------------- --------------------------------- (Plot ------------------ -----{Title) ---- 7.0 (Plot plan, showing size of,lot„-location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED�BY__/_.-_ ---- " '' --------------------- -------------------------- DATE----- REVIEWED8Y ------ ----- ----------- -------------------- ------- ----- --------------- ------------------------- DATE------- -- - BUILDING PERMIT 1SSUED t - ------ ------------------ ----- DATE--------------------- ----------------- Ai+erations and/or recommendations:_-------------- --------- - ------------------•-•- ----------•--------------------•---•------•------ i -•-------------------- -------•----------------•------- -- ----------------•-- ------------------------------------------ ------------------- ----•----------- -------------------------------------- -- - ---------------- =-------------- ---------------------------------------------------------------- -•---•-------- -- ------------------•--L-----------------•---------------- - -.-..___________________________________________________________._____.-_.._-_ -----------------------------------------•_---_:_--------..----_-•.------.---.-.--_-----------. ---.-----' FINAL INSPECTION BY:--------- ------------------ ----------------------------- Date - - ; SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street's ' Stockton,California Lodi,CaliforniaManteca,California Tracy,Caiiforniu ES 9 REVISED B-59 3M 3•'63 F.P.Ca.