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FOR OFFICE USE: / .,-•__-----------__---___-_-------_------------------- APPLICATION, FOR SANITATION PERMIT Permit No. ../k. .23 --- ----------------------I----------------------------- (Complete in Duplicate} a ..� _ . Dafe Issued ------ ---/�/i�� --------------------------------------------------- r This Permit Expires 1 Year From Date Issued 22Z:=3$C3�0S Application is herdby made'to the San Joaquin Local Health District for a permit,to construct and"-instalPe+n ;tl rdik herein described. Thls ap plication is,�inade in compliance with County Ordinance No. SW'i ►`; �F+ ,# �5�� JOB ADDRESS ANQ BLOC TION : [ © 100-0 VJ OF CA AA - =4- ! ` Owner"s Name -'- -----` .....- 0_H-N-------------------------------------------------------------------------------- .. Phone'-,---------"`--------•-- ---------- Address------ ------- ®= FScAl-On( '{ Contractors Name . -.. ------------------------------••---•-----•-------•-----•------- -------•------ Phone F f Installation will serve: Residence Apartment Housd;E];V Commercial ❑ Trailer Court ❑ Motel ❑ 'other,- r 1 � • . - �__-- �s _----- Number of baths _�--Lot size -------��i��- ---•--•_----._---- Number of liven units: __ Number of bedroom Water Supply Pub ic�systemY❑ Community,sysiem ❑ PrivateDepth, to Water Table,36 ft: y Character of soil o depth of 3 feef"--Sand Gravel Sand Loam '406 Loam Cla} E# Abe Hardpan Previous Application Made: (If yes,d"afe----------- No O�New Construction: Yes ®--No Q FHA/VA: Yes ❑ No 8-- TYPE^OF INSTALLATION-A-N SPECIFICATIONS: (No septic +ank'or cesspool..permitted if public sewer is available within 200 feet.) "rte Septic Tank: r , ,,Distance-from-nearest well--_------Yom.^;is#ane;from foundaF.ion--�- :--_-_Materia! ------------------------------ :Y _ No. of compartments--------------------------Size- }` --------Liquid depth__- "k� apacit ------------------------ Disposal Field: Distance from nearest well...:Sn-- -'Disfa ce from foundation----- ( '----.Distance,to nearest lot li�(---- ---------- �I JOIE Number of lines20 --------- --------__._.-_--____---Length of each line----- Y-_---Width of trench-._.'L------.----- --- . - � , , ��. .� it �------ - �} p D Ty, material of,filter..ma{erlal- ---- Total length--------------------�� ,p. ----------- -,.... Seepage P;+: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line------`---------- 171 Number of pits----------------------Lining material-.-----------------"Size ,Dia;meter----- ---'.r-----------Depth----------------------`---------- 3. Cesspool: Distance from nearest well----------------Distance from foundationt4 .��-I� :-Lining material--__.___---____-__-______----.---� ❑ Size: Diameter------------------------------=-------I-Depth--------------------------------------------------Liquid Capacity- -----------------------gals, Privy: Distance.from nearest well----------------I-----------_-_-------. g- --------------------------------------- t ---.------------------- -- - .---.._-._Distance from nearest building �' r ❑ Distance to nearest lot line---------------;--------- - _-------------- ---------------------- ------------------------------- - = Remode4ing*and/or repairing (describe):-------------------------------------------------------------=----------------- --------------•-------------------------------------------------------- x ,• a ----------•------•-------------------------------------•----------•------•---••-----------------•-------•--•--•---------------------------------------------------------------------- ------------'-------------------------------------------------•----------.-.------`---_-------••---------------__-`-.------•-`----------------•------------------------------------------------...---.------------------------- I hereby certify that l have prepared this application and that fWwork wit! be done in accordance with San Joaquin County ordinances, State laws, and les an regulations of the San Joaquin Local Health District. (Signed} -` -- - ------ -- ----- ----------- --•-------------'--------------------------------(Owner and/or Contractor) F •------ itie}_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)._ FOR DEPARTMENT USEyONLY "7X4Z T :w APPLICATION ACCEPTED BY--------F(R,-`--------------------------------------------------------------------- DATE---._._._-°_2�1 - REVIEWED BY------------------------------------1---------- ---_------- DATE--=--,----- BUILDINGPERMIT ISSUED-------------------------------- ---------------------------------------------------------------- DATE---------- -----------------------------------------------= Altera+ions and/or recommendations -.---------------------•--- •--------------------------------------•------------=---•--------•----------------------------------- ------------------------ ; i t• :_ -----_---- ------------------------------------------------------ - ----------------------------•------------------------------------------ - ------- ------ -_- . - - -------- ----------<`----------------------------------------------------------------=---------- FINAL INSPECTI BY: r rr.r---d------ --- - ----- Date--------------•-- ............ -------- --------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street .124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 31A 3-'63 F.P.CO. _