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--------------------------- ----------- APPLICAVON FOR SANITATION PERMIT . Permit No. .:.:.......:.... A w --.... -•-------- ---- -----1V {Complete_in Duplicate) -- ----- _(^ --------------------- - ---=----------- ------ Ij This Permit Expires 1_Year From Date Issued Date Issued _______ _____________ Application is hereby made to the San Joaquin Lara! Health District for a permit to construct and install the work herein des This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION,. -_. .. �:__.... ------- Owner's Name........./:�---rirrr�'�_-_ _-.-_-.-- ---------------••------- -- --------=-=---_--------_----=-------- ----•--- Phone------------------------ 01 „- Address------------------------- �1 -----------••------------------- . Contractor's Nam �a-s�. t s: -,&•C -----------t ------- ... P '. h Installation will se e: Residence 1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other Eli Number of living units: ---L- Number of bedrooms _' __ Number of baths ----I--- Lot size ___-P _•________ PPY: Public system ❑ Community system ❑ Q Water Supply: Private Depth to Water Table �_� f Character of sail to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam t2 Clay Loam ❑ Clay ❑ Adobe❑ Hard Previous .Application Made: (If yes,date--------------------I No [j New Construction: Yes E] No E] FHA/VA: Yes ElNo E] TYPE OF INSTALLATION AND SPECIFICATIONS: _ (Nfo septic tank or cesspool permitted if public sewer is available within 200 feet.) ; Septic Tank: Distance from nearest well-------____..--Distance from foundation--------------------Material---------__-_.------------------.--------------- (�A ❑ No. of compartments-------------------------Size------------------------------•-Liquid depth---------- -------------._Capacity-. ------------------- Disposal Field: Distance from nearest well-J-74--------Distance from foundation.,.--/-O/-------Distance to nearest lot line:C Number of lines___________ ___. � Length of each line-------7_a____ -------Width of trench.-.�__•__`}--"_.--_-__--_.__---_ I Type of filter material __ r#` -Depth of filter material------� _'�__---_Total length--__ 0-:._;-______________________ Seepage Pit: Distance to nearest wel _.____---_— --_-Distance from foundation--------------------Distance to nearest lot lin e_----__---_..---, ❑ Number of pits----------------------Lining material----------------------.Size: Diameter'---•--------------•__ Depth--..------------.---------._-•_-- Cesspool: Distance from. nearest well.."_:—-------.Distance from foundation._-----------------Lining material--___--_-.-.__---___--_--•--___------. "' I i Size: Diameter----`-=---------------------------Depth-:----------;----`'-----•--------- --l-,Liquid 'Capacity-------------•-= Privy: Distance from nearest:well------------------------------------------------ Distance from nearest building--------------.-------.------------------ ❑ Distance to nearest lot line. - z-- ----------•------------•-- ----------------•-•- ---------------------------- Remodelin and or repairing desc'ibe ........... ._. ---- ------------ --------------- ------------ -------•--- --------------•-----------------------._...- = ;i. = --------- ----------------------•--•• ------------------------. . --------- ;. --------------------7--------- - ~ 6 II hereby.. that I have prepared this application and that the work will be done-in-accordance with San-Joaquin County 41 ordinance$,,State'laws, and rules and regulaftons of the San Joaquin Local Health District. ; (Signe1��"7 '"''-�--- -------------- -------------------------------------(Owner and/or Contractor) cl� By------ - ------ 12: ...._..---------------------------- -(Title) - (Plot plan, showing ize o lot, location"of system is relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.- _. ............................ DATE...-•---�------W-.S =----------------------------- REVIEWED - --REVIEWED BY------------------------------- --- :------------------------•--------------------------------------- DATE----- ----------•--•-------- ...... --------------------- � BUILDING PERMIT ISSUED-------------- ------ DA•TE----------------------------------------------------- €:. Alterations and/or recommendations:.---------------••--------------- -------------------------•--------------------------------------•----------------------------------------------------- --------------------------------n::. --------------------------•--•-----------•--- ---- FINAL. INSPECTION BY ------------- SAN --•--------SAN JOAQUIN LOCAL HEALTH DISTRICT � 1601 E.Hazelton Ave. 300 West Cicik Street 124 Sycamore Street 205 West 9th Street %r Stockton,California Lodi,Cal 10 Manteca,California Tracy,California CB 4 AEV16E0 8-59 3M 3-'63 F.P.CO.