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FO OFFIfE USE APPLICATIOW FOR- SANITATION PERMIT Permit No. .r62g..7 -------------------- ---------------------------- ------- (Complete in Duplicate) -� This Permit Expires 1 Year From Date Issued 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 LOCA ION - -777.IR.PQh.1- �Q ' -l-�_h3 � n------------- Owner's Name...........IW/�:.�i.I..o....... M fl --------- Phone.......................----------•- Address-----•---1' TF..=... ----------:31P.-,Z- 1"/ T1�-C .---t- ---- ----------------------------------------------------------•-----•- Contractor's Name_A�-fFp c --_--•---------•------------........................ Phone.................................... Installation will serve: Residence [Apartment House ❑ &mmercial ❑ Trailer Court ❑ Motel ❑ /Other ❑ Number of living units: ./____ Number of bedrooms 3--- Number of bathsXLot size ,/ ................. Water Supply: Public system El Community system ❑ Private [Depth to Water Table _4-_ ft. Character of soil to a depth of 3 feet: Sand 8/Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No e"•New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted it public sewer is available within 200 feet.) Septic nk: Distance from nearest well___-----Distance from foundation__ 0----_-__-_.Material----�N��r->--- No. of compartments- _ != _______Size..._,3A__7/Y.!57Li uid depth..... r Capacity � Dispose Field: Distance from clearest well �V-_.._Distance from fou dati ......O-___. .Distance to near�estll Lt line �_...... [ Number Qf lines=_ __ Length of each ;; Width of trench--------f.`/.'i .._.. �... ',� Type of filter material-- Depth Depth of filter t�iati _____.� _______t__Total length... ,R 'Seepage Pit: Distance to nearest w -___r-_ ' tance from foundat' Distance to ne t lot line '..__...A/ -- ❑ Nulm6er of pits----------------------Lining material-----------------------Size: Diameter------------------ .._.Depth--------------------------------- Cesspool: .-.___ . -..__---____-_.._---- Cesspool: Distance from nearest well-----------------Distance from foundation...----------------Lining ❑ material-.__.__..-._______--_-__._________--. Size: Diameter------ ------------------------------De Depth--------------------------------- ------------------Liquid Capacity ----gals. Privy: `' Distance from nearest well----------------------------------------------- from nearest building----._-___-_-.___________.___.--__....... ❑ Distance to nearest lot line----------------------------------------------- -------------_--------------------- ------ -------- •--------- •------- ---- = 1^ Remodelingand/or repairing (describe)------ ------------------------------------------------------------ ------------•----------------------------------------••--------------•---------=-• ,h -------------------•----------------------------------------•--------------------------•---------------------•------------------------•------------------------------------•--------------------------------------•--------- 1 ' ----- --------------- - -------------- ---------------------------------------------------------------------------------------------------- --- -------------------- ------------- -------- yt• I hereby certif A# I have prepared this application and that the work will be done in accordance with San Joaquin County S ordinances, State ws. and rules- d regulations of the San Joaquin Local Health District. (Signed).—,--- - ---- ------ - ----------------------------------------------------------------------------------.(Owner and/or Contractor) �Y ---------l'-- ------------------------------------------------ --- -- - -------------------- -------------- -----(Title)--- -------- ----------- ----- - -------------- (Plot ._.: - -----(Plot plan, showi size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ,rF�OR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY-----------7te-R,-- 0-------------------------------------------------------------- DATE------ff.�- �/ ---- REVIEWEDBY------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED...........--------------------------------------------------____................................. DATE------------------------------------------------------------- Alterations and/or recommendations:-------------- ----------- -- ----------------------------- ..__ ---- ` - ----------- � 'j ` fl � L-- ------------2- "----------5 _D_Kr_ --------1� 1_-D_rH1 ------ f=--------Ta �-N ----�-� . --------Z'4----- ------------- - -----Wr-----------t�'`R----------- ' -- - ----- - --------------------------------------------------------------------------- i.la fn FINAL INSP Date---------/ -------- SAN JOAQUIN LOCAL HEALTH DISTRICT / 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-S9 3M 3-'63 F.P.CD.