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FOR OFFICE USE: �' + permit No. /,73--_--- . I �_7APPLICATION FOR SANITATION PERMIT ,. t �Grt � ri- _-. _-:_ (Complete in Duplicate] - ' Date Issued C. -----------'_------_"_ _ ___'"___ _ ___ ______ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construe and install the work herein described. This application-is made in compliance with County Ordinance No. 549. r'' 4r7—I.3o �ey �J�..� JOB (ADDRESS-AND LOCATIOIou �_.--------- --- ------ 7tA' - ---- - - --------- •-------------•-- ` p ' Phone------------------------ Owner's Name----��---- -- •-------------------•-------------------------• ---------------- ------------------------------------------ ------- ------...__._.. Address s ••. '�'r' � ------------- = F ' Contractor's Name----------- ---------------------------- Installation Phone Installation will serve: Residence jo Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of.living units: _ _ Number of bedrooms.s3___ Number of baths _ -- Lot size ._---.� ------------------- g ___ Water Supply: Public'system ❑ Community system ❑ Private Depth to Water Table-5- ft. } Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam.Clay ❑ Adobe ❑ Hardpan-Q , Previous Application Made: (If yes,date ---------- -- No ❑ New Construction: Yes ❑ NoW FHA/VA: Yes ❑ No :d TYPE.OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.), ) r __ --Distance from foundaflon___ D_._.-__.Material----f �__- - ---------_-___.. Septic Tank: Distance from nearest weli_�__. � � - � -- ----- - Q No. of compartments_----. _______ - .__-5izec� - --------Li uid de th___._-y_-____-.- ___Capacity--1--401 r /� q R : , .�� _ is - , Disposal Field: Distance from nearest well,Sb._____.....Distance from foundation= __.S__:_"m�'Distarice to nearest lot line-- # Number of lines--_-----/--------. ._ � p Length of each line-----7s'..............._ -Width of trench_..__/_/- ------ Type' of-filter,materialSjJ?'_ __.Depth of filter material----- _______To#al length__-----------------------�S_________ Seepage Pit: Distance to nearest well �a-�,_'-- --Distance f m f`'undation---2a_--_•---Distance to nearest lot line-. -____ ^( Number of pifs-------�------------Lining material- ________Size: p sr� '� T SizE: Diameter__ {.-------Depth--- -- - # Cesspool: 3Dista nteifrom..nearest.well---------._�-----Distance from foundation--------------------Lining material-----.------------------------------- El Size: Diameter'.`-.------------------------ Depth- ---------------- -------------------._Liquid Capacity----------------------._-_..gal . j Privy: .Distance-from nearest-well-------- from.nearest buildin ---___..... ❑ Distance to nearest lot line- ------------ --------- ------------=--------------- ----------------------- --------------------------------------------------- -------------- Remodeling g ---------- b Remodeling and/or repairing (describe):- _ _ _--- ---�"C�.I�i --�---- ----- --- - - •-- - �. L�� t ------._-- ---------------�-- ------ ---------------------------------------------------- _ •---------------- ------ � `_&---------------------------------- ---- - Z -- -- ---- ---m" ----��---•rte-"v--=--=�� -t_..------ --- }--�------ -------------------�----------- -.....__�-`�'-i�---------- fir- ---- r I hereb tify tl�at I have prepared this application and that the work will-5e done in accordance with San Joaquin County ordinances Stat laws,;and rules and regulations of the San-Joaquin oaquin Local Health District. f -----------------------•------- Ener and/or Contractor) (Signed) _ ---------- - (3 ------ ------ [Title) Y:---------------- –— ----- ----� . (Plot plan, showing size of lot, location of system.in relatia o wells, buildings,.etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - -��- DATE lfi --------------- APPLICATION ACCEPTED BY -- --------- - --- ------------------ REVIEWEDBY. = - = ------- ------ DATE------------------------- ---------------------------------- BUILDING PERMIT ISSUED ----------- - ------------�---: DATE - --------------------------------------------- ---- - -------- ------ n./�r` `_ s-art r ` Alterations and/or recommenotions:._..___ ___ . .. ----------------'•------------------------------- ----------'----......-----"------------------•---• --------- ---------------- I -- ------------- --------------------------------------------------------------- FINAL INSPECTION BY._.:�" `"-- �� --------- Date ------ --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT y 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Cr 9 REVISCG 8.59 3M 3-'63 F.P.CO•