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FOR-OFFICE USE: ---- ------ -- ' __________________________________..___._._______ APPLICATION FOR SANITATION PERMIT Permit No. ..-.� . .. ------------------- (Complete in Duplicate) J t Date issued ------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describetl. This application is made in compliance with Count Ordin� Na, 5 ��J Z2cj _ In-70—(D ForaS . 4-A-T�& � , X_U44,ffV�� JOB ADDRESS"AND LOCATION---- •-- - -- -- ----- ------------------- ---- - ----- --------- - --------------------� -- ----- ----• - - -' U�sm- _ Ownes's'Name----' ame = ; �� f -------_------ ! ---- -- ----------- --------- '-- Phone---- _ Address----- --------------------------- -- - ------- - -----------------------------------K ------------- --- ----1--------//-•- ------------------- Contractor's Name ------• -------. t.---------------------------------------------------------- Phone4_!G'_ke/ ..... Installation will serve: . Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ { Number of living units: _(______ Number of bedrooms .2—.. Number of baths __{_____ Lot size .__ ___________ ____________ ---------_......________ ' Water Supply: Public,system ❑ Community system ❑ Private J> Depth to Water Table4 ft. Character of soil to a idepth of 3 feet: Sand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam P§' Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date----------------_---) No New Construction: Yes ❑ No +jFHA/VA: Yes ❑ No ❑ TYPE,OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspooh permitted-if public sewer is available witliin"200'feet:) . Septic Tank/- Distance from nearest well-- Distance from found _._ ation_ _'j.____.Material-._-___.___.___ _ l.-1 __________________ &,S7 No. of compartments----------'------------- Size--------------------------------Liquid depth------------------------.-Capacity----------------------- Disposal Field; Distance from nearest well_________________Distance from foundation__________________Distance to nearest lot line----------------- ❑ ks`I lX6 Number of lines-------------- --- ---------------Length of each line----------------------------- Width of trench--------------.--------------------- •-t�; .Type of filter material----------- ___________ Depth of filter material------;_.--------------Total length------------------------------------------ -� s r i Seepage Pit: Distance to nearest well- Q'�________r Distance fro foundation__-AE1__----------Distance to nearest lot line_._00_____._ Number of ----Lining material- --------Size: Diameter --------- ------------------- ,S 1 Cesspool: Distance from,nearest well------------------Distance from foundation------------------ Lining-materiaL__-.___________________________--__. - Size: Diameter----------------------------------- ---Deth----------------------------------------------------Liquid Capacity gals. Privy: Distance from,nearest well---------------- ------------------------------Distance from nearest building--------------------------.--------------- ❑ Distance to nearest lot line-----------------------�-------------------------------------------------------------------------------------------------------- -- --lY Remodeling and/or repairing (describe)--'--- --- ---- --- - -- ------- ------------------------------------ -- = --••----------------------------------------------- -"--------------------------------- ------------------•------•---------------' ------------------•------------------'------------------------------------•--------------------------•-----•-•--•--•--------------•------•-••----------------------------•------------------------------------- - I hereby certifythat I h e repared this application and that the work will be done in accordance with Sam Joaquin County y ordinances, State laws, and ule and regulati s of the San Joaquin Local Health District. IN Owner and or (Signed) ----------- -------------------- -- ' ' ------ ------------------------- - .?reverse on rac orJ i a- -= $Y-------------------- ' r --- ------- -- _-{Title)----`:,�- _ (Plot plan, showing-six; of,lot, location of system in-relation to wells, buildings, etc., can be placed side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ,0--- ----------------------------------------------------------------- DATE------ ti 15X REVIEWEDBY------------- '---------------------------------------------------------------------------------!------------------.------- DATE-------- --------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------- ---------- ----------------------------------------------------- DATE---------------------------------------------------' Alterations and/or recommendations:__.._•----P.L r_ c--------104@01ACZ;;------pp��, --f--------------------- --------------•------f--{--L-l- sa--r---------- ---------- >. -- ----` -------------------t---------------------------------------------------------------------------------------------------------------""----------------------------------- 4 .... ...... .... . '---. ---------------------------------------------------------------------------------------------------- ' r n� FINAL fNSPEC � r� Date---' ' ' �' ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED S-59 3m 3-'63 F.P.Co.