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FOR OFFICE 7------- } -�--- ------------- ------------------- .-___ ----------------- APPLICATION FOR SANITA7I0N PERMIT Permit No. e�.c ..,3 •� -------------------- ..(Complete.in Duplicate) ------------------ This Permit Expires 1 Year From Date 'Issued 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, JOB ADDRESS AND LOCA710Nr F S __�S'JClI jed, •�,r/7 i¢ f Ow War's Name------,ow... ��r:r -.------ - a` --- one ---------•-------- P. Address-------- 7 -.4 _ Gam.. / . G -'-- f ----------------------- Contractor's Name + h / !/ ------`-------••------------- •------- •-----------•--- Phone-----------•---------•- r Installation will serve: Residence ❑ Apartment House ❑ Commercial ,❑.,Trailer Court Motel ❑ ,Other ❑ Number of living units: 4! ___Number of bedrooms NumberV. of baths __�.._ Lot size- Wafer Supply: Public system ❑ 'Community s stem y y ❑ Private j?"'6epth'to Water-T'ble a ft. Character of soll to a depth of 3'feet: i Sand ❑ i.Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe lardpan 11 Previous Application Made: (If yes,date____.._-_.__-:.__.) No (P-' New Construction: Yes K?-'no ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.)--'- # Septic Tank: Distance from nearest well-----------------Distance from foundation__._----____--s_+__Material--------------- .__.______._ � .: x No. of compartments Size--------------------------------- iquid depth---------- -------------- ----------- Capacity Disposal Field; Distance from nearest well-__._..----- --Distance from foundatn-------------- -__.Distance to nearest lot line___.__________._ ❑ Number of lines----- ----- ---------Length of each line-------------------------- Width of french-'----------_-- - -------------- Type of filter material-------------------------Depfh;of filter.11 .material__:_'_ :-`Y_ "e`-Total .length___-__- __._-_----____ Seepage Pit: Distance to nearest ell.-3990-------Distance fr fo ndation___-'^'--- ._--.Distance to nearest lot line- Number of pits____ _____________`Linin material-__X fd Size: Diameter_ . ----- �� Cesspool: Distance from nearest'~-----------------Distance from foundationining mate�iaL ° .:: """ _.'--_- ----- ❑ Size: Diameter_-___�______- -_- - -----'-'-' �-Depth------------------------- ---------------' - '�----Liquid'CapacitY-----------------------------gals. .. Privy: Distance from-nearest well--__..`_________________________- -_._______._.Distance-from nearest building____:,_._____._______- „_ r :• r Distance to nearest'1ot line.__' _.:_._-____ ” - - f i .rte E � Remodeling and/or repairing (describ6):w ------ � ' z7� e----_--__ ---•----- --- --------------- ------------------- -----------•---------------------------------------------------------------------------- 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)------------------------- - t�J- / `---- ---- -I�r Contractor) f BY: - - =------------ (Title) ' ' (Plot plan, showing size of lot, location of system in ion to wells, buildings, etc., can.be placed on reverse.side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B -- ------- "� s DATE -------------------- ------------- - ---------------------------------- REVIEWEDBY--•---------------------- ---------------- ------------------ -- - ---- ------------------------------._._ DATE BUILDING PERMIT ISSUED----------- E # -- ----- ----- AT ----- --------------------------------------------- Alterations and/or recommendations: � 4?_y_.�-- :.,�__ - -._ _wt� �y f - ,. (f �e.�.t - _ ______________..________._.__ -f ________________________________---_--_----__-----•--.______._--.--___-- ______________________________________________________________ -------------------------------- -----------------------------`---_--..._.-' ------------------ FINAL .INSPECTION, BY Date_ S --='- -�--r'-Vic.-'7--'-'-- ---- ' -- ------------•- ". SA'N JOAQUIN LOCAL.HEALTHDISTRICT 1601 E.Hazelton Ave, f 300 West Oak Street 124 Sycamore Street 1205 West 9th Street � Stockton,California Lodi, California Manteca,California Tracy,California GS 9 REVISED B-$9 3M 3-'63 F.p,D D. V s.H�