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FOR OFFACE USE: ------ OR SANITATION PERMIT Permit No. ._,� .'��1 --------------------- ------ APPLICATION F / ----------------------- (Complete in Duplicate) -, Date Issued -------1-_..j2 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 escrib d. This application is made in compliance with County Ordinance No. 549. yr�c JOB ADDRESS AND LOCATION_je/A.../........ ------- _.____._-mac.--- ---- -- ------�' - _ ---� Owner's Name--------- -• � ..•.--•- ---• -- *------------------------------------------------------------•--- ------ Phone.................................... Address ----------------/eX...---' !�----_-------,------------ ` `` _f--6-------------------------------------------------------------------------_ Contractor's Name-----------1001 ----- rr --j-----•-------------------------------------•---------•-----•-•------•--•----- Phone................................... Installation will serve: Residence's Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/____ Number of bedrooms __'3-:_ Number of baths __1----- Lot size ..... ........X...1_}�fJ____________________ Water Supply: Public system ❑ Community system ❑ Private [; Depth to Water Table _/Q_ ft. Character of soil to a depth of 3 feet: Sand tK Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No JK New Construction: Yes b' No ❑ FHA/VA: Yes ❑ NoR f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt;`- .Distance from foundation---4 `-------.Material-_ ------------- _ No. of compartments---------2r.----------Size--- X.S_'?�_ ---Liquid depth._-$ i.. _._.Capacity.!_ OD t Disposal Field: Distance from nearest wellTltft-C._Distance from foundation----!-G.........Distance to nearest lot line____ Number of lines-----------1.............. Length of each line_____ -----------Width of trench:-_---_-�3-__--___---__.___-_____-- Type of filter material.__ _:_._Depth of filter material___--_—Z 3-----------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-------------------------------------. ❑ 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):-----------P- 4 V_V_ -------- -- -- - ........ -------------- •---•-•---------••-- --•-----------------------------------------------••------------••--•---------•------ ----------------------•---------------------------------------------------- -----••------------------------------------------ S ____________________•_-___-_-__-.__-.----_____-_.___--___-___--_-_-----________------__•_-_---_-__--___--.•----___-_______-_-_-_----•_--_-____-------__-_-____.-______-.__---._-_____-----------.-_---._------.---__-_--_.-___ _________________________________________________-------------------------------------------------------------_________________________________-------------------------------------------------------------- --------- I ________I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health-District. (Signed) -----------------------------------------------------------------(Owner and/or Contractor) BY� ---------------------------------...(Title)......... '.-- --- - -__-_------ (Plot plan, showing-size of lot, location of s stemin relation to wells, buildings, etc., can be placed on reverse side).FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- '----------------------------- ---------------------------------------- DATE----------.��----•�--- -----,- ------------------- REVIEWEDBY------------------------------------------------------------------- -------------------------------------------------------- DATE--------------------------_---------------------------_-- BUILDINGPERMIT ISSUED--------------------------------------------------------•---------------------------------- --------- DATE---------------------------------------•-------------------- Alterationsand/or recommendations-------------•-----•-------- -------------------_-------------------------------------------------------------------------------------------- ----------- --------------------------------------- ----------------------- ---------------------------------------------------------------------------------------------.............................................................. --------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- FINALINSPECT -- ----- -- --- ---- Date---- ------ ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 3M 3-'63 F.P.CD.