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/5/, FOR FOR OFFICE USE_..� PERMIT � - �• �. -. ^" - -� �-- ;� , S� APPLICATION FOR SANITATIONPermit No. ..Z.7. I. ------------------------- - -------------- -- ------ (Complete in Duplicate) rf! --------------____________.-.._-.._-.--------_.__-___ ___ -� This Permit Expires 1 Year From Date Issued_ Date Issued ----•-- ---! 6y Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 5 . . JOB ADDRESS AND10 TI N----- 7 �f� � Owner's Name---�i t ------ Phone------------------------------------ Address....... ----------------- Address------. ------ - ------------------------------------------- Contractor's ------- - ----- ---- Contractor's Name t � -� -•------- --- -------------------- _ ------------. Phone-----•---------------- { ----------- ---------------------------------- Installation will serve: (Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑- Other ❑ Number of living unifs:,___.j__ Number of bedrooms .--.3_ Number of baths _1-__ Lot size __f4' XI_2-D_____________ Wafer Supply: Publicjsystem Community system ❑ Private ❑ Depth to Water Table .- _Oft- s) Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adobe �ardpan ❑ x Previous Application Made: (If yes,dote---------------------) No New Construction: Yes [!I'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � rZe Septic T nk: distance from nearest well__ _______ Distance from foundation_- ____o_______ ____Materlal_-____�_______.______.___________.___.________. No. of compartments---- -----------------Size-__-a_Y 3�Y_F---------Liquid depth---I--------------------Capacity--kQ_Q__ - , Disposal Field: Distance from nearest well-__�__._._-Distance from foundation__��?_-----------Distance to nearest lot line-P?�_._. r Number of lines------:-PZ----------------------Length of each ----fO.e-----_-.Width of french---2-4---,»--.--------------••- : Type of filter mate rial�Q_G_�C_____Depth',of,filter ma"terial----/$-.'_____.__._Total length-----/S.__0__'r----------------------- yY < < Seepage Pit: Distance to nearest well__--- -------------Distance from foundation---1Q._._._.___.Distance to nearest lot cine:�_________ r, r, / %y Number of pits__2--------------Lining material�bil_C_�_-_-__Size: Diameter---�3_____...___.Depth____,Z_iu___------------------ Cesspool: Distance from nearest well-----------------Distance from foundation- -- ___Lining material_ El m Size: Diameter-----------' -- ------------------ - ---Depth---=- ------------y---.-------------------------------Liquid Capacity---------------------------- _gals. Privy: nearest l --------------------- -- ------ from.nearest building-`_._____._____________________ Distance to nearest Iel- - ---- ---- - - -------- -- Remodeling and/or repairing (descibe):-------------- --- !�' —te ------- ------------ --------------------°Z-� ---------- -;- ----------------------------------------------------------- ------------ --------------------------- •--------------------------------------- --------- -- -------------- ---------- F ' --------------------------------------------------------------------- ---------- I hereby certify that I have prepared this application'and thaf'the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules and regulations:of the San Joaquin Local Health District. �` _ T __ (Signed)----------- ---------�-p-------------- --- ------------------------------------ - '=----------------------------- ------------------...(Owner and/or Contractor) I By:------------------s5.!_ �---- ----- - -----------------------=----------------------------------------{Title)------------------- -------------------------------------------- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --------C:... ..,r.cr1 . ----•---------••---- ---- DATE----------�-2/___ , --------- ------------------------------- ---------- 'REVIEWED BY--------------------------------------------------------- ------- ---------------------------------•----------------------- DATE------------------------------- = - A BUILDING PERMIT ISSUED------------------------------------------------ --------------— DATE 9 Alterations and/or recommendations-------- ------ --- -- - ------------ '-----------------------------------------------------•-••----------------•---------------- ------ a:r 2�- -�` - � ------------ ----------- --------- --- Z�,P_2_-C','5-�---� ��ra• �--�= ------------------K -------- - --------- f -------------------------------------------------- ----------------------------------------------------------------------- ------------------------------------------------------------ - 1 FINAL INSPECTION BY:.. T�c�r�------------------------ Date --------------------------------------------- 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 l ES 9 REVISED 9-59 3M 3-•63 F.P.0 D.