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FOR OFFICE USE: z6=6 --------------&_301 _ .. _ APPLICATION FOR SANITATION PERMIT Permit No. .-_-Z--•-----_5 ---------------------------- --------- -- ---- --------- (Complete in Duplicate) 9 a G --- --- --- -- ----------- ------- ----- -- ----- -- is Permit Expires j-Year From Issued Date Id Date Issued -__ l__-._... � - Q$7 — '70-28 Application is hereby made to the San Joaquin Local Health District for a permit to qwstrucf and jnstall the work herein described. This application is made in compliance with County Ordinance No. 549. Lf Z-7 ,51, JOB ADDRESS AND LOCATION-- _fv�, z��----��'�/ �'"'" '' --. ---- - n . Owner's Name--- -- y► . . 1� �- : { � ----------------- Phone--- . ' r ; Address i - l _ __r �a t ---�... t = Contractor's 'Name---_ /j r `' f - c /�� .--------- --. Phone. ��.. ----- Installation will serve: ResidenceAp *t*House ❑ Commercial ❑;Trailr-Court�[]•--Motel ❑ Others❑ r j I t Number'of living -of-bedroor4s _=, Number--of,b�ths _______,`Lot`Sim -_.- _ _ __ ------- -----1-- ------------------------ Water Supply: :Public sysiemr❑;i im:munity•system(,E) Privgf Depth to Water Table ----- ft. Character of sono a depth feet: Sand Gravel Sa h Loa�rrtt.nCIaLoam Cia Adobe Hardpan P ❑ ❑ YL ❑.-..: y ❑ y ❑ C Previous Application Made: (If yes,.date--------- ----------) No ❑ New Construct.ion:,WYOIS,,.E] No ❑ FHA/VA: ❑ No ❑ �► TYPE OF INSTALLATION ,NA:tPEC`I riCATIONS � (No septic,tank or cesspool permitted,,if}public sewerls'avar(aksIs within 00 feet.)• Septic Tank: + '�&Distannce fror1.ni;ear sst well� y,._��D stanc fr&n foundat*�h-`u_0"'0"*" Material _ -. ."'!�'�.. _-6-14------------ �1 ❑ e,Ct'S*�: No.of comparfrne'nts"� S w~ • q . . P ` Capaci , .. Disposal Field:: ``—Disfance from nearest-weE1__.�, /___Wistance from foundation____________ _____Dis ante to nearest lore:"�� . line----------------- El �aC,l'IST Number of lines------------ _-____---..__-Length of each line----4.0!7- -------- - of trench_ -_�� ------------- � � ) Type of filter _____Depth of filter matertal_._..f ___...Total I length_____ _ __________________ Seepage Pi�:; Distance to nearest well-----X- C � Distance from fo ndation___________________.Distance to nearest lot line-..- �__._._ i -r Number of pits---- ---Lining maferial__,c��.............Size: Diameter______T----_.Depth_...__-_.._ -_ : essp'oo o y Distance from nearest well-----------------Distance from foundation--------------------Lining material--.-___- _ --_--_________-------- ❑ Size: Diameter---- - ------------- ---- - -- ---- Depth- ------------ -------------- ----------- - --------Liquid Capacity- - -t .gals. Priv Distance from nearest well-------------- ------ _Distance from nearest building_ ,...��....� Distance to nearest lot line------ - ------------------- --------- ------ --------------------------------- -- —Remodeling and/or repairing-(d ribs ' ------ - — -- ------ f �.___ .-. _''�` `G �'____----- r f ' -------------------------------------------------------- ---------------------- ------- -------------------------------------------------------------------------- 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. (Signed)------ -F�f r fes/ .f es I%f_;!''------------ ------------------------------------(Owner and/or Contractor) ---------------------------------------Title (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 i - -- ---------- - -- - APPLICATION ACCEPTED BY_.-_.. - AR/1'/__.---__ DATE.......__. /24- _- _ -------------------- ----------------- -- REVIEWEDBY- ------------------------ ------ ----------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------- ------------------------------------------------------- DATE------------------ ------------------------------------------ Alterations and/or recommendations:----------- --------------------------•----------------------------------------------------------------------------------------------------------- ----- -------------------------•-------------------------•------------------------------------------------------------------------------------------------------•----•---------------------------••-------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------- ---- ----------------------------------------------------------------- -------------------------------------------------------------------- --- FINAL INSPECTION BY:.- ____Y -------- - Date............. ------------------------ --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. 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