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FOR OFFICE USE: k` --------------------------------------------------------- -------------------------------------------------- ------ APPLICATION "POR SANITATION PERMIT Permit No. __--_ _-----•----- - .e (Complete in Duplicate) Date Issued ._'-71111014 '' ----- /110 ----------------------------------------------------- --- This Permit Expires 1 Year From Date Issued ! Z``f�s _o qp- 2-flO 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. IM 1i1,tT-Cf3 JO ADDRESS AND 'LOCATIONl'7 ' --------- ------O �r{ .f: Q_. I---- -- ___ Owner's Name- >'•--►• w. �«. �� - ---- Phone-- ----- Address--------- P_J!... - --`-----bd --� 7•-----------------i----------RI-Po-a,------'- ---- �`- _� _�. ................ i Contractor's Name -- - -- - ..._--------------- ----------------- ---------------------------------- - 1-------------: ..._ Phone-----_------• ------------------ Installation will serve: Residence Apartment House ❑ Commercial Trailer"Court ❑ M;el,❑. O�thher�E y Number of,living units: _� _.__ Number of bedrooms __ Number of,baths -------- Lot size ...._! ____ __�_______________ Water Supply: P b(lic!system Q Community system ❑ Private [Depth to Water Table 25 ft. Character of soil fo a depth of 3 feet: " Sand �Gravel`�"Sa dy aam ClaL m ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (Ifiyes,date---=----------------) .No [ New Construction: Yes No ❑ FHA/VAd Yes ❑ No TYPE IOF;INSTALLATION'"AND SPECIFICATIONS. (Na septicfank or suss oole5mitt d if public sewer is available wifhin 20U feet.} ." p"r""= Lit,...._.: Septic Tank: i tante from nearest well-----__ _---- Distance from foundation- -_ Material'________________________________________________ STI NG— �o. of compartments----- -------------- Size----______ Liquid de pf"h�:._ _ - --_--.Ca eci Disposal Field. Dl Lance from nearest well---------------!.Distance from foundation.,------ `_-...Dis4tq nceYto nearest lot line--_-----_-_-�t__ F_X Tlti1� 2 -I Len th of each line_ [�D� N�mber of lines--------------•---------- --- 9 �'��----! -�-"Width offrench---��--6---:�--'�---�------ • ;: Type of filter material AOC„�___�-Depth,of,filter,material---_-f-..___.___Total length-------------��----_----_--_-_-_---- IF I , . t � Seepage Pit: Di;tante to:nearest well----------------------Distance from foundation--------------------Distance'to nearest]ot line----------------- ❑ pits---------------------Lining material-----------------------Size: Diameter----------------- ---Depth----:---- ----------- - ------- Cesspool: D stance fr} l p r € oi'n nearest well_________________Distance from foundation___________._______.Lining material___.___!--.__--_-_ -__._._________. -----Li Liquid Capacity_ __gals. ❑ 7 Si�e: Diameter------ ------------------------•----.Depth-------•------- --------------- - - - 9 1 P Y--•--;-----------------•- Privy:. Distance from nearest well--------------------------------------------- _ ------- - _Distance from nearest building._------_--}_..____-___ _-_-.__..___---. ❑ 4 Distance to nearest lot line------ ---------------------------------------- ----------------------------- W Remodeling and/or 'repairing (describe: -•--- -v --------------•----•----.--•-•--•--------------------------------- -------------------------------------- •---•------------- --------------------------------------------------- -- ------------------- --- ---------------------------------- ----------------------------- ----- 1 u I hereby certify that I have prepared this application and that the work will be done in accordance with`Sari Joaquin County ; ordinances, S" laws, and rules Od regulations of the San Joaquin Localr Health Disfrict, V, f Lt,y (signed)----: ----- -�--- -_;----• ----- ----- " ; - --- 11-L-- -------------------------------------------------------(Owner and/or Contractor) ---- .--- Title-------------------s (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can,be placed on reverse side). -, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.__'._.:" i "" r =- - - - REVIEWED BY.- �": = = "= = = - " "�. = DATE_ �` ----------- ------ -- BUILDING PERMIT ISSUED.-----------`-- --------- - - - ----- - --- - -•_.,., ._�,�DATE_--=.------ -------+ --...�,.Alterations and/or recomYmendations -------- -------s ----------_ -----_------------ -_--------- --- ------------------------------------ ----- --- - - ------------ =--�--- ------- r-------��------------------------- ----------"----------------------------------- ------------------------------------------------------------------------------------- ------------------ ---------------------------------------------------------- --------------- --------- -- --- Date ' ---------------------- - -- - ------------------ ....... FINAL INSPECT Date. ._`-, �o fir= SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California c Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.DD. [ / � t