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FOR OFFICE OSE: All �Y {�-�. APPLICATION FOf ' SANITATION PERMIT Permit No. .f ___C___./._.._ - --------------- ---------------------------------- (Complete in Duplicate) Date"Issued a --------------------- This Permit Expires 1-Year From Date Issued ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried I This application is made in compliance with County Ordinance No. 549. FEMA ` -- - ------------ JOB ADDRESS AND LOCATION........ <,4/fel- Q.�4J____. ---•- Cl '---- �a------------------------------------------------------- Owner's ----------------- - - - e!?._...Y- �cc� 1�x----------------- Owner's Name---------- -- - --------------------- -- ------------ Phone------------------------------------ Address-----------)?-,/-•-;--..... °//------------- ---/----------------------------------�----------------------•------------------------------•---------------------- o9 -----------------------------•---- Contractor's Name----- �t......Cr=Q t!`rP�° G--�_/• ----- -- ------------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial .❑- Trailer Court ❑ �M7otel ❑ Other ❑ Number of living units: ___"____ Number of bedrooms _--_Z- Number of baths /-____ Lot.size ___ry-C h's'4 _ _____________________________ Water Supply: Public system ❑ Community system ❑ Private © Depth to Water Table c;P_4_ ft. Character of soil to a depth of 3 feet: ,Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ , Adobe FX] Hardpan Previous Application Made: (If yes,date____________________I No 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.) I Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material____-_.______________.-________-.__.-._.__---_- ❑ No of compartments-------------------------Size----------------------s ---Liquid depth------------------------..Capacity---------------------- Disposal Field: Distance from nearest well...S__Q -_._.Distance from lfoundation----ZO-----------Distance to nearest lot line_ IE 5,T'JWC— Number of lines--------------/-------------------Length of each line-------,x -- -d _1-------Width of french...... f- , �2_1,4_- -----_------ 4op'. Type,of filter material____.PQC.t_____Depth of filter material---_/-. ______-__Total. length_______S6�4_ _______________________ 1 Seepage Pit: Distance to nearest,well-__,l._U-d--------Distance from foundation----l'A/r------Distance to nearest lot line..... -._____ ❑ Number of pits-------I-------------Lining material----..,0CV....Size: Dia mete r-y_?C-_�"_�..._.____..Depth------/,3--------------------- Cessool: . p � nearest well -Distance from foundation_____________ ______Lining material____--______--_____._________ ._.__.. �- 1 ❑ Si Diameter_ ------------rDepth----- --------------------------------- -----------Liquid Capacity--------------------------..gals. Privy: Distance from nearest well------..-- --------------------------=--- Distance from.nearest building_;---------------------------- -------- ❑ Distance to nearest lot line_________________`___: `'---- Ji Remodeling and/or repairing (describe)----------------------------------------------------- -----=----------------------------------------------------------------------------------------- t� ! �f------�Q------4-� �?�1n1- ----------------- ----------------------------- --------------------------------------------------------------------------------------------------_---------------------------------•----------------------------- F P ____________________________ __________________________________________________________________________________________________________________________________________________________________________________________ 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. (Signe 0-0&61'�E --- `- TV 5` ../ / _ _...._ 4�'±�'�------------------- ---------------------(Owner and/or Contractor) )---- . By:-------- ---- ------ ----------------------------------------------------------•---------------------(Title)---I?"t r G e.,Pzu (plot piers, showing size~of I ;~location=of system-in-relation to-wells;=buildings, etc.,-can-6eYplaced-on-reverse side). ..� i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------- DATE------ --a-- - REVIEWEDBY------------------------------------- -------------------------------------------------------=----r--•----------------------- DATE-------- --------------------------------------------------- BUILDINGPERMIT ISSUED-------------- --------------------------------------------------------------------- ------------- DATE--------------------- ----------------=----- -------------- Alterations and/or recommendations:-------------------------------------- ------------------------------------------- --------- - --- ••------------------ ---------------------------------•------------------------------- ------------------- ------------------ ------• ---------------------------------------.-------_-------------- ----------------------------- ------------------------------------------------------------ --- - --------------------- = - ---------------------------------------------------- - - ---- - ---------------- - -------- - - - ----------- FINAL INSPEC BY... . Date---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California _ = Manteca,California Tracy,California E5 9 REVISED 6-59 3M 3-'63 F.P.GO. 1