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F R OFFICE USE: �_-ire / � _ ____----_---------- ------ APPLICATION FOR SANITATION PERMIT Permit No. .__l_�F/�G?.... ------------ ----- --- ---------------------------- (Complete in Duplicate) p 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI -_ 3.01._.._..So.,---14L.L?.Ei_.B.ElZT--------, ------------------------------------------------------ Owner's Name---AR ..... _ffaEL.___....'m�� L .-- -------- -- Phone//>17_-_6_910_`Sy_ Address. ._-_._._s� �.__ _ Contractor's Name__/" I _Rj_,S.b------ A--C-•----------------------- ----p--------- _--------------------------------------- Installation ------------ ..--------------------.Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j--- Number of bedrooms _2-_ Number of baths __/._ Lot size _4T®.,x--.1 __5_1____________--.--_-__-_ Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table 46-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam;❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date---------------------) No D New Construction:' Yes ❑ No [F FHA/VA: Yes ❑ Nom' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: )d7 Distance from nearest well..........:......Distance from foundation--------------------Material.------------------------------------------------ ❑ 6Y IST No. of compartments------------ --- ------Size--------------------------_...Liquid depth-------------------------.Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line________--______- ❑ ISTI Number of lines.._--_______.............__---_-Length of each line------------------------------Width of trench-___-_.----_,._-_-_.._--_-__-_-__ � Type of filter material_________________________Depth of filter material-----------------------Total length_--------_______-___-----.-____-------__.- l� __Distance to nearest lot IineJ'� Seepage Pit: Distance to nearest well _ .___DistanceJ;o"�oundation_____ ________ __.-_.-__.-- V) Number of pits--.-_/-------------Lining material--- Diameter. ��.-._.-__:..__Depth...Z..�__---______--_---- . Cesspool: Distance from nearest well, r __Distance from foundation---------_--------__Lining material----.-------------------------.-_____ ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------------------------------------Liquid Capacity------ --_---_--- -----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________._____.-_-__-_,---_\`.______.:_.� ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------- ---- A - V Remodeling and/or repairing (describe):___- ¢_�v--.---:T ----�FA_c_3..nno-6....... _ - _-------_-- ------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 of the San Joaquin Local Health District. (Signed)__._____f 41oation 1_ -�� .A--..--.___._-_.-_______._ ....___.(Owner and/or Contractor) ----------------------------------------------------- - BY� ------(Title)----�-`�-T----------------- - - --- --------- (Plot plan, showing sizof system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY /10/(APPLICATION ACCEPTED BY--------- - ---------------------------------------------------------- DATE--- I-,?04..r�.---------------------- REVIEWEDBY------------------------------- ---------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------- ------------------------------------------------- _- --------- DATE------------------------------------------------------------ Alterations d/or co 'me tns_ ---� --- _ ---_ _ -_-_-_-_�____ `---------------------- ` ------------------------------------------- ---------------------------------------- ---------------------------------------------------------------------------------------------------------.--------------------------------.--.----------------------------------------------------------------------- FINAL INSPECTION BY:-----cl!Zr- -------------------------------------- Date------- Z - ------------------------------------ SAN -- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-S9 3M 3-'63 F.P.CD.