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FOROFFICE USE: -------------------=------ ------------------- ------------------------------ ------ .-.--.--_--_.................__ APPLICATION POR SANITATION PERMIT Permit No. ----------------------------------- -------------------- (Complete in Duplicate) � 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 described,^ I This application is made in compliance with County Ordinance No. 549. . ��L�JI IN GlD� i JOB ADDRESS AND LOCATIO __ �� ___.- ��-P �op- _ --�--__ , ----------- - -- -- 1 -__F-----C4M-P i3- �- --------- Owner's Name-----`4-- x 1�_5. o� 5�_ + �JJ ----- -. Phone-- -------------------------------- -------------------- Address-.----------- _'_•--S..4- - /_ cI-) Contractor's Name 67 F�-------- ------------------------------------------ -•--- ---•------•--- Phone-----... .......-...------- Installation will serve: Residence'RApartment House ❑ Commercial ❑ Tr1ailer Court ❑ Motel ❑ Other ❑ Number of living units: '.-- Number of bedrooms -3-- Number of baths f/2_ Lot size _. G tr} ------------------------ Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table357 ft. -� 1 Character of soil to a depth of 3 feet: Sand [KGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ . f , Previous Application Made: (It yes,date----------- -----} , No 1?�New Construction: Yes [!I' No ❑ .FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: k (No septic tank or cesspool permitted if public sewer"is available within-200.feet.) Septic Tank: Distance from nearest well----------�- Distance from foundation----_!-------------Material___.--.' _ -_----_--.--_ __._--_-------.---_-_--_. F_�T)N"6— No. of compartments------- ------------- --Size-------•------{------------ Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well----------------,Distance from foundation--------------------Distance to nearest lot line--------_---..._. 1�"�ST1 N/C; Number of lines:- ------Length of each line------------------------------Width of trench------------,-------------------•- T 13E� Type of fitter material---------------- -Depth of filter material----------------------- length------------------------------------------- F7 1 LT - Distance to nearest well----- .�_ Distance from*fouridation_ t 'scan o nearest lot line,,- Number � '.=' ^-- Number of its. _ Tl t p -Lining material_R-0-CA_..Size: Diameter': X:. Depth__._ RIO C_K Cesspool: Distance from nearest well-----------------Distance from foundation-----------------I�. Lining material--_-_---.--.-----__.--..__-_-_----.--. ❑ Size: Diameter---. r ------------------------l-Depth---------------------------- -----------4.�=!_Liquid Capacity----------------------------gal Privy: Distance from nearest well--------_______i-_._____.._____._.-------------Distance from nearest building.-T.....---.--_____________._______-__. ❑ Distance to nearest lot line---------------------------------------------- - i Remodeling and/or repairing (describe):-- ------ -------------___ t ----------- --•----- --- " --------------------------- -- ------ ------------------------------------------- ---- ----------------------'---.__.__--------------`---------r--- -----------------------------------------•---------------------------•------------------'•-----------------------'-------------------'--------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Lr ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 41 + (Signed)----------------------------- - -------------- ---------- --- (Owner and/or Contractor) n t By------------------ -------------------•--•------------•--•--_`:.___------------(Title)---------------- ------ --------------------------------------- (Plot plan, showing siz of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY iir APPLICATION ACCEPTED BY----- ------------------------------------------------ --------------- DATE------- +�� y� REVIEWEDBY--------------------------------------------- --------------------•------------------------------------- --------------- DATE--------------------------------- . ------ BUILDING PERMIT ISSUED--------------------------------------------------------•------------------------------ -. DATE.--------------------------------- T -Alterations a-nd/or recommendations:------ ------------------------------------------ ------------------•--•--•----• ------------------•--•--------•---•-------•---•------------•-------------- +a % � k1 --------- ----------------------------------------- ------------------------------------------ -------- - - ------------- -'-- ----- --------------------------------------------------- ---------------- ------------------------ G.Q j.,' � tR-- � ! Iq - a FINAL INSPECTION BY:. -� -Z --------- Date-- �`�r� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street s Stockton,California Lodi,California w'"Manteca,California Tracy,California ra.. ES 9 REVISED 5-59 3M 3"63 F.P.CC.