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FOR OFFICE USE- -------------------:--------------------------------- SE:-------------------:--------------------------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. a` -- ---------------------------------- ------ ----------- -_ (Complete in Duplicate) f " Date Issued --- ---------------------- ----------------- ._.--------------- 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 described. This application is made in compliance with County Ordinance No. 549. C�'LC? JOB ADDRESS AND LOCATION -- � ------------------------------------------------ F->_L ' T ---- �� 9------------•------------ PhonemeOwner's Name--..__-- - ; 5� l Address---------------- Z-.----- / 4/'C------1Q:-40- ate -� .,` / Contractor's Name-.._- ti71 f//Q'fl Al 1`.l ?�' .� `.. Phone Installation will serve: Residence Ap6rfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ `3 r '1a F. Number of living units: --------.Number of bedrooms -_ Number of;bathsv ,___Lot size .....-.. --�------------------------- Water Supply: Public system ❑ Community syst m" ❑,''Private l Depth to Water Table ?_0 ft. Character of soil to a depth of 3 feet: Sand ,-G.ravel ❑' Sandy}Loam•Q) Clay Loam ❑ Clay ❑, Adobe E] Hardpan ❑ Previous Application Made: (If yes,date-------------- ❑ -) No New Yes No FHA/VA: Yes ❑ No L H 5 TYPE'OF INSTALLATION AND SPECIFIC TIONS: I _ ! (No septic tank or cesspool permitted'if public sew^e� is available within 200 feet.) _ t Septic ank: Distance from nearest well-----------------Di0ante from foundation----.-------------- Material----_.._--.---.-------_-._--------------------. No. of compartments-__''--------------------Size---------------_--------1-------Liquid de th--------------------------Capacity of Disposal Field: Distance from nearest weir. 0.---.:Distance from foundat••ion-_,4~___.-_---.Distance to nearest lot line--.�_-.---_- w� .�� ' ' • Number of lines----------------/----�-'-''-----Length of each line---�--�-D-1___�-----.Wid#h of french------[ ------------------------- ---- �---------------------- Type of filter material--_-. Q_ i ---_Depth of filter material--_-/.�_-.-_---._Total length-_-.----��--------------------_.--. y 3 / \A ' Seepage Pit: Distance to nearest well.--_J-40--------Distance from f/oundation---.�_-_...._-_.Di tancP to nearest lot line ----.__.. ❑ Number of pits._..--_�-___-_--.-Lining material_ jc-/y___'_.Size: Diameter-_y_ _ __-----.Depth....--1�-___.__-_- A _, 5 - Cess ool: Distance f16r ,rieare'st4`well` '�._.--- •Distance from faundataon--------------------Lining material------------------------.- £ Q ❑ Size: Diameter------- b ------------Liquid Capacity- ----------------- - gals. r � f Privy: - Distance from'-nearest, ------------------------------ ------------ Distance-from..neares# ❑ C L,' �A buildirg_-.-----_------_---._-_.-_--- ------------------------------------ - -Distance'to neareWlot lire -----------r----------------- -,w.,--- °- i Remodeling and/or repairin (desc.ibej,_%----k--------------`------ ------ --- --------------------------------- -f ---------------------------------=------------------------------------------------------------------------------- ------------ ------------- - 1. I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County tA ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. 031 (Signed)._--C l� 11" .571-- eja4r C"0p.e - .... jj� ------- --------------------------------------(Owner and/or Contractor) 'By-' �^ - tem -- relation - - we___-------"--�_------.---_ Title:: dam!_ - --I _ :-. (Plot plan, showing size of lot ation of system lis, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r � APPLICATION ACCEPTED BY---- f--�- �. -- -------------- ---------------------------------------- DATE---------- '14---6 _ -------------- - p REVIEWEDBY----- ------------------------------------------- -------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------<C------------------------------------------------------------------------------ DATE------ --=------------------------------------------------- Alterations and/ar recommendations: '"r----- --------------------------------- ------------------------------------------•------- --------------------------•-------- --------•------------ -- ----=-- --------- ----- -- ----------- --------------------------------------------•----------------------------------------------------- ------------------------- --------------------- -------------------- ------------------------------------------ FINAL INSP�C�h+ [�1_fSY • = - , Date--..... , / -� .-� ------------------------------------ -"- i SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Maxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3-'63 r.P.CG• h