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F OFFICE USE: ' �G� �_ �Z(D — {C� g� Com, (/��' ad 7---------- ----- --- -----------------------------_--. APPLICAT)O !"AOR SANITATION PERMIT Permit No. __.�.7. _3 --------------I--- --------------------- -- ------ (Complete in Duplicate) ,f y ___.___________________________ This Permit Ex ires I 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 ompince with County Ordinance No. 549. JOB ADDRESS A/N� C TION_0 �I � _ .0 _. ------ •---.- --�-1 -�------- - e - ------ Owner's Name---161 z Address------ t-1.3--j— -- -----------------------------•---• --------------------------- Contractor's Name '`'1 ° Qr-- '-•- •�ls'.�F --------------- Phone4z- 4.3_y�. ---- Installation will serve: Residence [],Apartment House ❑ Commercial ❑ Trailer Court ❑�'Xptel Other ❑ Number of living units: ___ __`Number of bedrooms ' .- Number of baths ---L_ Lot size _ _._______ ___. - _ _____._ Water Supply: Public system ❑A ICommunity system ❑ Private E---D`epth to ter Table _____ ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam Clay E] Adobe E] Hardpan [3 Previous Application Made: (If yes,date--------------------) No ❑ New Construction: YesA-No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S .Y Septic Tank: Distance from nearest well_��^C __.__Distance from foundation_X-__Q_OF___ prial_______________________________ No. of compartments-. Liquid Liquid depth----l- ---a_...'.---------Capacity---[ __ �nn P r ^ V► Disposal Field: Distance from nearest well ...Distance from foundation___ �f .......Distance to nearest lac line._-.��.._.. Number of lines-_;� -- -- Length of each kne_s `sr?--_r Width of trench�Ci_!__��___-____ Type of filter material ___ __ -_.____Depth of filter material____l__ ___ Total length-------------_/,--__-.-_-__-- Seepage Pit: Distance to nearest well-__________-________Distance from foundation___________________ Distance to nearest lot line__-__.__._____-_. ❑ Number of pits-----------------------Lining material-----------------------Size: Diameter-----------------------Depth--.------------------_----_------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material-__-____-______-___-_-__________-- (0 ❑ 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):---------------------------------------------------•-- •-•----•---------..---- - --------- -- •------- _ --•-----------------------------------------"-- ` ------------ --AIc�rt�.l - -- -`�-.-------- ----------------•------------------------------------------ --•------------------------•----•-----------------------------------------------•-------------------------------•--------------- ------------ O ----------------------------------------------------------------------------------------------•--------------- --•-------------------------------------------------------------.------------------------- ------ 1 hereby certify that I have prepared this application and that the work will be doe in accordance with San Joaquin County ordinances, St t law and rules and regulations of the San Joaquin Lohil Health Dis riot. (Signed --- r- ---------- - --- �- �--��FLiza - ------- ---Teeln/rk ------------------------------ -� or Contractor) . ------ -- -----------•-- -•----•- _ ------------------------- (Title]-_ (Plot plan, showing size of io+, location of system in relat' n to wells, build) s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------- _ ----------------------------------- DATE---------- --------------- REVIEWED BY--------------------------------------------- ------------------- DATE - --------• ----- BUILDINGPERMIT ISSUED-------------------------------------- -----------------•--------------------------- ----------------- DATE----------------------------------------------------------- Alterations and/or recommendations---------------- ------__----------------------•--•-•----------------------------- ------------•------------ ---------•------------------------ ----- ------------- ------ --------------------------------------•---•--•---------------------------------------------------•----•---------------- --------------------- -------------------------- ---------------------------------------------------------------------------------------------- •-•------------------------- ---- ---- ----- -------------------------- ------------------------------ -•-------------------------------- ----- = -----------• ----- ------------------------------•-------------------------------------------- q / FINAL INSPECTION BY:------ .............. -----ZX-5---------------------- - •Date------.. - ---f �-�/-------------- -----"----------------- 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 4 REVISEO 8.59 3M 3-'63 F.P.CO.