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FCS OFF,ItE USE: --------------- --- ----------------------------- ---- - APPLICATION FOR SANITATION PERMIT Permit No. -------- -- ---------------------- ------ {Complete in Duplicate} s Date Issued - Iz_, ov 3 g'"-------------------------- --f Za t This Permit Expires I 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. This application is made in compliance with County Ordinance No. 549. S 0-7p— JOB ADDRESS AND LOCA ION-------.&-"e_6- /'`��/--------e�� 5 -_mak'-1 a ---------------- 5 c-1 f.-Q i� . Owner's Name----------J-0---�-------------J- 6--s- t-0-------------•----••-------------------- ----------------- ----- -- ------ Address------------------------f t----l--- ��: � �1-------- 1-5.. -..----- -- -----------.1------ ------------------.-.--•---••----------------..-_---------------- ' ��Contractor's Name------ ------ ------------------- Phone..e15 �-`.�- -�- Installation will serve: Residence Pq---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -::t--- Number of bedrooms Number of baths -1--,Lot!size,---`' 4n .. -.---_----------_--.--.- Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table -:,,---3 ft. i F Character of soil to a depth of 3 feet: ; Sand [4 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: [If yes,date........... .......I •No New Construction: Yes L�}'`No E] FHA/VA: Yes E] No,� TYPE OF INSTALLATION AND SPECIFICATIONS:. -. (Na septic tank or cesspool permitted if public sewer is available Within-200 feet.) a Septic ank: Distance from nearest well----------------r_ Distance from foundation--------------------Material------------------------ 1-11 !4�- No. ofcompartments--------•-----------------Size--------------------------------Liquid depth--------------------------Capacity-_----------------- Disposal Field: Distance from nearest well__ L�_._-Distance from foundation----_4l`- --_Distance to nearest lot I ii Disposal Number of lines----- -------1.-_...............Length of each line_---_._�-v-- �-.---.Width of trench--- EX - l� J_�- 1<'---- �- q- AII) P, Type of filter material-----_00' C—e_'Depth of filter material-----/ ............Total. length.------- ':: ----:"------------------ �3 R 1 Seepage Pit: . Distance to nearest well___ /Q v---.----__Distance from foundation_---__LS...�_-.-.Distance to nearest lot;line--�.---._.... Number of pits------- -----------Lining material_----.PL4CI _-Size: Diameter_Z- ------ Depth /.. --- ...................s:_ , Size: Diameter----------------- -----------------De th------------------�undation--------------------Lining material-----="---------------------------• Cesspool: Distance from nearest well-----------------Distance from fo p ❑ - P ------------------- --------------Liquid Capacity-.--7--'�--------------------gals. Privy: ,Distance from-nearest well------------------------------------------------- from nearest building--------_---------_----------------------- ❑ Distance to nearest lot line------------- -------------------- ------------------------------------------------------------------------------------- -------------------- f Remodeling and/or repairing (describe):- ;------- -----------•------------------------------••------------- --------�+ -----------------------•-----•------------------- --•--------- - -------------------------------------------------------------- -------------------- ------------------------------------------------------------------------------- ---------------------------------------------------- a 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 off the San Joaquin Local Health District. " Ile (Signed) � Q-� > 1i=, .�7� ---- _C fr' . '.--:I � ----.�----- -----------------------------------------Owner and/or Contractor # t _ - Plot Ian, showing size of lots tattoo of s stem in relat i ------------ e - - rile Sy:-------a -Z--+-- ; __�.. ------------ ---------- _-- --.-[ 1 _ A' r _ ( p g y ion to wells, buildings, etc., can be placed on reverse side}.-- FOR DEPARTMENT USE ONLY 0 APPLICATION ACCEPTED By------------ .� .•- ---------------------------------=-------------------------- DATE----- R 'S REVIEWEDBY------------------------------------------------------------- --------------------------------------------------------------- DATE-------------------------------- -•---------•------------ BUILDINGPERMIT ISSUED-------------------=------------------------------------------------------------------------=-------- DATE--------------------------------------------------------------- Alterations and/or recommendations:---=----- -------------------=--------- 111-. -----------------------------------------••-•------•--•-----••--•--------------- 1 ----------------------------------------------------------------------------------------------------•-------------------------------------------------------------- ---------_-------------------------------------------- --------------------------------------------- ------ ---- ------------------------------ -------------------------•-----------------•------------------_ ---------------- ---- ------ - ------�- ---- ----.-. ---------•--- .- --W- -------- ----- --- Date /FINAL INSPECTIO Y:- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy,California ES 9 REVISED 13-59 3M 3-'63 F.P44. 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