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F R OFFICE USE: >� •' Permit No. -1.7'�-- " "7---- -- -- --------- APPLICATION FOR SANITATION NITATION PERMITf , ::-.._- (Complete in Duplicate) _ . ---------- Date Issued = _V17.-----fes, _-_-___---_---- -_-- This permit Expires l Year From Date Issued Local Healfh District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin This application is made in compliance with County Ord' ante No. 549. JOB ADDRESS AND L kON__. - - --� � � Owner's Name Phone. dam__ -• 0 r ---- ------------------------ ----• Address---•------------- ------------ -- - - - - - - - ---=-------------------- ------..__....._.�--•--------•--------- Contractors Name-----=--------- -- ----- Rr,-. --------------------- Phone----•-----_------------`------ Installation will serve: Residence 8;�_Ipartment House ❑ Commercial ❑ Trailer'Court ❑ Mo-tel ❑ Other [I Number of living units- _"".Number of bedrooms __Number of baths.-/-- Lot size , ------ Water Supply: Public!system �Coinmunity system ❑ Private ❑ Depth to Water Table� 'ft. T Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made (If yes,-date-------------------.1 No [�K New Construction: Yes Flo ❑ FHA/VA: Yesl� o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance froth nearest we�_______________ __Distancil ram foundation__ "-___-_.Mate faL- _ - - -------- �/ ��r ----- Liquid de th-__'l� ----------Capacity-- --- ��---- No. of compartments_-_ ' Disposal Field: Distance from nearest well.___`'_.-.-_Distance from foundati x.Q-------Distance to nearest lot line__ Number of lines_______�____ __ ___�j________Length of each line___ -` _" ,------ --------------------- -----Width oftrenchL.�__. W nearest lot ine_0 ______ Type of-filter ma;--- l_��/ /��epth of filter material ` ____"",Tota! len th_-__ �-""""- ---------- - < / V1 �� Distance to < Seepage it: Distance to nearestiwell___.__-----_._._.___Distance f m fo ndation_____:__ ____ � , j - Size: Diameter_- �y Number of pits---------------------Lining material. _ -- --------_.Depth_-Ze _-. /#. �' 0110 Cesspool: Distance from nearest well_______________a__Distance from foundation-------------_------Lining material-___---_________-----________-__-__- ❑ Size: Diameter--------:---------- ------ ----- Depth----------------------------------------------------Liquid Capacity--------------------- `-.-gals. ' Privy: :.Distance-from nearest well-------------------------------------------------Distance from nearest building-------------------------------------- :-- y Distance to nearest lot line------ ------ ---------------- ----- ------ -----------------------...----------------- ------•------------------------ --------- - , Remodeling and/or repairing (describe)::---------_-- � 1 _ ------------------------------=----------=------------ ----------------------------------------------=--------------- ;k - - ----- --------------•----- ------------------------- 4 - - --- - --- := - ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, Sfafe laws, and rules and regulafons of the San Joaquin Local Health District. ft her ar Contractor) ---------------------------- -------- ------- -- -(TitIfT ---'-�--------- ------- --------- lel ' (Plot plan, showing size of,lot, location of system in tion to wells, buildings, etc., carr be placed on reverse.side). FOR DEPARTMENT USE ONLY Ik dill, APPLICATION ACCEPTED BY ------- ' t ------------------------------------------------------------- DATE-------------- i �6 REVIEWEDBY---------------------------- - ---- ----- DATE------------------•---------------------------------------- BUILDING PERMIT ISSUED----------------------------- DATE Alterations and/or recomme ations:-- -------_-------- ------ --------------- ------------•------•-------------------------------------------------•--------------------------------- FINAL INSPECTION BY:------- �� _"� -------------- Date ---- — --------•------------ � r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 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 a-59 3M 3-%3 F-P.CC.