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FOR QFFICE USE: -------------- -------- - _______----._-----------------------------_------------ �APPLICATION FOR SANITATION PERMIT Permit No. ..,1 ------------ -------------------------------------------- (Complete in Duplicate) Date Issued _________ ____�� _____/=A� ----------------------------------------- --------------- 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 f elein described. This application is made in with County Ordinance No. 549. R tj'r �A -�t AJC JOB ADDRESS AND LAO^CATION---J-�__ W �'��R .....oOUf�, - '�°?'�,` Q_ t4_T .> a ...__. -Q. Owner's Name--------------3�t�R�-�--......t-°'- F_R1,,E7 --------------------•-------------------- Phone•-----•--•---•-•----•--•------------ Contractor's Name------ ................... -------------- Phone................................... will serve: Residence Apartment Houle-❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms_. Number of baths _/---__ Lot size -------If____-_--�__; AiE .-----_---.- Water Supply: Public system ❑ Community system ❑ Private :;Depth to Water Table _f. ft. Character of soil to a depth of 3 feet: `'Sand 8-"'Gravel Sandy Loam [-] Clay Loam E] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date.''<-----------------)�N`r New Construction: Yes ®--No ❑ FHA/VA: Yes ❑ No 2' TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted tf lic sewer is available within,�00w�eei.) - Septic Tank: Distance from nearest well ----.--_Distance from foundation--------------------Material--------I----- I--_- -------------- -- ------- F�`T1 AIC-r- No. of compartments--- -- Size---------------- -- t Liqu;3i epth -t Ca acitY Disposal Field: Distance from nearest well - 6 ,,_Distance from foundation....��___.__�fSr3tan'�d #i neare�t lot line___......... F�STI N G Number of lines_ ____ - Length of each line--------7,0 ---- --..Width of trench_,'t .3rraf,_ c4- 1�D A• Type of filter materia?--- - .Depth of filter<ma#eril_...._.f Total length ' -• -----•• - _ Seepage Pit: Distance to nearest well � a3rstet I ,rp ounda3ion .._____ Distance to nearest lot Ime_________________ ❑ Number of pits---------------------'Lining material-----------------------S& . 9+afneter----------- Depth)-------------------------------- Cesspool: -----------------•-•---------Cesspool: Distance from nearest well__::--------------Distance from.foundation..------------------Lining material------------------------------------- 1 ❑ Size: Diameter-----------------------4--------------Depth----------------------------------------------------Liquid Capacity----------------------------gaeoe r , Privy: Distce from nearest wel4�_"<_:___._._____._____.•_________________Distance from nearest building------------------------------------------ ❑ Distance to nearest lot ling ----------------------------------------------------------------- i , Remodeling and/or repairing (describe):---- t --------------------------- --- -------•-------------- - -•----•-----------•-------- ---------•--------------------------- tti. -- == __-------- ---•--- ------------------------------------------------------ -------------------- M, ------- --- --- ------------------------------------------f -- ----- -------------•-------•---------------- ---------------•-•-----------•--------------•------ +------------------•--•-•----------------------------------- r''" I hereby certify that halve*prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and #!s and re ulations o the San Joaquin Local Health District. (Signed)-- --------- -------- -•-- ----" '`' - '--------------------------------------- --------------------------.(Owner and/or Contractor) v BY: --------- + } Title)..... - -- (Plot plan, showing size of lot,�Iocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLI14XCC 5PTEP2Y,,; ��- --------------------- ------------ ----------- ----- DATE----- /-� ��-�r�---- `' REVIEV&ED Y -- ----- --------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED-- ---•---_. ........ --------- -- ------ -- ....- -- DATE. ..:.... .......... ...........__—---------- Alterations -------Alterations and/or recommendations:----------- -------- -------------------------------- -----........ ------------------------ --------- -------- -------------------- ----------- -------- - ---------------------------------------- --- ---------- ------------ ---- ------ ---------------- --- ------------- ' `n FINAL INSPEC = Date--------------1P.---- 1Z.3--------6-3------------------ 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 8-59 3M 3•'63 F.P.CD.