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F1 LC u3t: � b-Y: ------ " -------- --------------- = --------"_"--- APPLICATION FOR SANITATION PERMIT Permift No. . (Complete in Duplicate) -------------- ------- --- This Permit Expires 1 Year From Dale 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 in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_:____" - 23,'57-12 Owner's Name------------"-• _"- " Address----- Phane_ �� f5e� �� ._/,.---....-- �---- - e C� ------------ --------------------------------------------------- --- - Contractor's Name--- ----------- - r.. p Installation will serve: Residence Phone__ _ [�A arfinent House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other E] Number of living units: ___1__ Number of bedrooms 3"- Number of baths _ 2s / ----- Lot size ---------- 9 -------- ---------- ------��__ � Water Supply: Public system ""---- •- Y Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam 2-'Clay ❑ AdobeHar Previous Application Made: (If yes,date---______________--] No ❑ dpan ❑ [ New Construe}ion: Yes ❑ No [� FHA/VA: Yes ❑ No 0--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availableithin 200 feet.) - 4 Septic Tank: Distance from nearest wel! _____ -Distance from foundation ❑ ----------------""- - - No. .of compartments----------I--------------Size------------""_-- .Material------ -------------- ------Liquid depth---------- .........Capacity----------------------- Number of lines-Disposal Field: Distance from nearest well Distance,from foundation_______.___ ___--_.Distance to nearest lot line----------------- ❑ ----------------- _---- -- _ -----------------Length of each line---------------------- Width of trench -''------- Type of filter material__________________" Depth'of filter material-___.____- _ _ g------ . Seepage it: Distance to nearest well------------ Distance .moi / "�"-�- undation_____ _______Distance to nearest loft line_ Number ofpits___--._..Y------.--Linin maferi S Lining --�- ��- Size: Diameter_".*�'3`' � Cesspool. Depth -------------- U1 Distance from nearest well-----------------Distan foundation_..-_-_--_------- Lining materiaL_._.__-.__.__.__".__-""- Size: Diameter------ -- --------------------- ----Depth------- - i --- Liquid Capacity--------------- rn gals. rivy: Distance from nearest well____________________"""__--_ _ _ _Distance from nearest buildin + ❑ Distance to nearest lot line--------- -- --------- ------ --- g-- -------------------------- ----------- -- r - ------------------------------------ Remode#ing and/or repairing (describe):--------- -----------7-,�"" ""�1� -•-------------------------------------------- ---� - -------- .•21p'/•Y' -------------------- ------------------ ------------------------------------------------------ -------------------------------- ---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, States and regulations of the San Joaquin Local Health District. (Signed)_ / �-7 T -------------------- -------- -- f J -- _ w rand/or Contractor) ---- By: )Title)_.._ ._ (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side). i FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__=:_-----__---- -tea ` ` GATE ----------- VIEWED BY---- --------- - ------- -------- --- ---- ---------- ---------------- DATE------------------------- UILDING PERMIT ISSUED-------------�-------- ------ _ _ _ _ -- ------------------------ -� DATE------------------------------------------- Alterations and/or recommendations:_".___-..-�� -�-� -_, "- _•�_�-�-�—_ - _ _rte= --C>-.._t_.0 --------------- G - --------- ------------ - FINAL INSPECTION BY:------- - G�c r� •L1 �- �1� ------------- SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Flazal}on Ave. 300 est Oak Street 124 Sycamore street 205 West 9th;tree} Stockton,California L,di,California Manteca,California Tracy,California F.P.C Q. � w