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FOR OFFICE USE: ------- ' - >� APPLICATION; FOR SANITATION PERMIT - Permit No, __ -____ ---------- ------------------------------------ ----------------- -------------------------- (Complete in Duplicate) Date Issued _"f/----------_--- - -- --------------------------------- This Permit Expires 1 Year From Date 'Issued 1-77 - 2-po- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ ed. �ap� with County Ordinance No. 549. Thls application is made in compliance`: / �� , �,ff /,, JOB ADDRESS AN LOCATION-----► _- �IGtG -�� P j y `'""--'� e- -.-.-Phone---. .�.v9 u.3712 rte- V 4,�. T ' z ••------------------ ---- Owner's Name •M!�I�. 1 --` - ,��-jf--�--------- Address_.. , ---�O---- -- ------- --•• --- a '/ Contractor's Name--------- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Ot 4 f Number of living units: _"'__ Number of bedrooms -- Number of baths _X__ Lot size _ _ _-------------------=-,--------- Water Supply: Public system [Community system ❑ Private 0 Depth t, meter Table _ V4 f+. Character of soil to a depth of 3 feet: Sand E] Gravel [_1 Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date---_- _-) No � � E]New Construction: Yes No FHA/ VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------" Distance from foundation-_/t-_ ____.Material__ -�¢F •-------- --------- lr` s [k ' No. of compartments---s3---- --_ -----Size_OW-61-X- -Liquld€depth dl{ _Capac�tyf ` C > B-----_-Distance to nearest lot Disposal Field: Distance from nearest well_._"�.___._Distance from foundati.on_y _ -- . Number of lines______►_.".-__ _�__-___Length of each line___ cif--------------------Width of trench_.__._""____ Q s ------------------ -Total len th _/11__6V---------------------- ' `Type of filter material__��Depth of filter material___-�O. -_�-� 9 s t� _""Dist�ce to nearest lot linj��-___-_ Seepage Pit: Distance to nearest well------.'" ="_--___Distance from foundation-__2 _ s ----De th_12�- - -- (�/' y Number of pits---- ------------Lining material__��--Size: biameter�r,�_ p -------------- i Cesspool: Distance from nearest well-_______!-______Distance from foundation-.-__ _____________Lining material----___--_-______--_____- -________ Q 171 Size: Diameter------------------------- - ---;- Depth Liquid Capacity Privy: ^� S I I Privy: Distance from .nearest well-------- ----------------------------------------Distance from nearest building-_____----____-__ _-_--------------------. Distance to nearest lof�yline------ ---- - - s ❑ ------------------------------------- •- - •-- - ---------------- Remodeling and/or repairing (describe):--------------- ----------------------•-------- ,. .1 ----------------------------- 1 --------------------------------------------------------- -------------------- - ---------------- ----------•------ -----------•--------------- _: ------------------------------- ---------•-- - ------------- 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. ----- r Contract --- (Signed)-.-------- -- ---- - - --- -------- --- -- �o (Title)- i (Plot plan, showing size of (at, location of system i _r ation +o4rells, buildings, etc., can be placed on reverse side). 1. FOR DEPARTMENT USE ONLY 9 �' , /� DATE- APPLICATION ACCEPTED BY------ -•=-----------------------Y---- - ---- t ----------------------------- - % P/--------------------------------- - REVIEWED ----- --------- REVIEWED BY----------------------------------- ------- DATE - BUILDING PERMIT ISSUED------------------ i°----------- -- � .__ DATE - -- AAlterations and/or recommenda+ions:------ .- ---�-------------- --------------•• ----- .. er ,€ --------------------------------------------------------------------------------- ....- •- ----------------------------------------- ------ ---_- FINAL INSPECTION BY--------------------------- ------ �l"" Date------------- /tel 7 ------- 1 - ' SA JOAQUIN LOCAL HEALTH-DISTRICT IL . V 1601 E.HaxeHon Ave. 300 West Oak Street 1 24Sycomare Street 205 West 9th Street Stockton,CaliforniaLodi,California Manteca,California' Tracy,California ES 9 REV15t=0 8-S9 3M 3-'63 F.P.CC. p A r