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FPR OFFICE USE: ----- - ----- --------------------- - Permit No. -. _--__.. ----- �-- ------------------------ftp.- APPLICATION FOR SANITATION PERMIT --------- - �c-'#----------------- --3c! (Complete in Duplicate) f--..-..-- 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 i•n compliance with County Ordinance No. 549. JOB ADDRESS LO ION-.C:::,' nl� r lUX22"",--------la--- c Owner's Name-&q ---------------------- Address---- -----••---e Address L( ---------------- -•--.. . ----- ---- --------------------------------------- -----•-----•--•--------------------------•---•-- J Contractor's Name__ ----= -`- ... �_ -r -----------••------•-•------------- Phone_.�/6..(� � / Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ®.__ Number of living units: __-.____ er of bedrooms Number of baths __ Lot size ._-_-- _ __fx- _ ----- - Zj___ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. 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 ❑ New Construction: +Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_49!7�_Distanc� fromiroundecon__- __-_.Mate No. of compartments---- C __--Liquid depth------ +-- Capacity-/; p -�y-- �41C� Dispo al Field: Distance from nearst well--k(a11-,._Distance from foundation._f ___________Distance to nearest lot line____ Number of lines_____ ____ _ _ ___ .__ ______Length of each line___._ _P__f__._______Width of french---C,,---.. ----- K th`of filter material-----,1-�,`-____Total length --�___ Type of filter material_ ___ 4• __ p g x Seere Pit: Distance to nearest well -_______Distance from foundation___- ___ _r_.Distanc��to nearest lot line---- /p �"tj Number of its--_-_�---------------Linin G_material :.__.Size: Diameter_._ -_-Depth-_. "____-___-___-_- Cesspool: Distance from nearest well----------------Distance from foundation------------.------ Lining material__-_-___--_____-_-___---_-______ ❑ Size: Diameter------ ----------- -------- } :Depth_-_-------------------------------------------------Liquid Capacity----------------------- gals. Privy: Distance from nearest well______-._-_-------------------------------------Distance from nearest building------.--------------------------------------- ❑ Distance to nearest lot line-- --- ----------------- --------- ---------------------------------------------------------------------------------------------- Remodeling and/or repairing {describe= --------------r--------- ---- -------------------------------------••----------•------------•-- -------------------------------------------------------------- -------------------- --------------------------------------------------------------- ------ ---------------------------------------------------------------------------------------------------- - - - ---- - - I hereby certify-that'l have prepared thil4FAication and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, nd rul s and regulations of the San Joaquin Local Health District. (Signed} - •. T' b?._C J1 -------------------------------------- i d�bvContractor} r3y:.-• -•------------------------------------------------------------------------------------/s, tiilidings. {Title) -------- ....-_ ------------ (Plot plan, showing size of lot, location of system in relation to wc., can be placed on reverse side). / - -------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY l�/ ---~�----------------------------------------------- DATE--------- - - REVIEWEDBY------------------------ ------ --------- -------------------------------------------------------------------------------- DATE--------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- L • -D--A-"TE----`-------------------f'---�---.f-l-y----------------,-r-�-_ ----�-------- _ Alterations and/or recommendations---__� _c` - "-- ` �c- ----------------- ---------------------------------,- y' c� - --- - - �: Ir----- --------`------�? --- c- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------- - ----- FINAL INSPECTION BY:-_ ._y_.. ." ------------------- Date- -- /-- - ---- -•�- / f F SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVMEG 8.59 3M 3-'83 F.P.CC.