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FPR OFFICE USE: { y(A r Permit N3 o. ------------ APPLICATION FOR SANITATION PERMIT ----------------------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issue ; ---------- ------- ----- ----------------- ------ 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 O dinance No. 549. '0 '�' _ a --- JOB ADDRESS AND LOCATION - -Phone---•------------------------ Owner s Name---------- --••- ----- i ry ----------------------- Address__ ~`""" ' ---------- - = ::. ------------------ - ❑ -- = = } Contractor's Name---- •---------- J9 T e ❑ Other ❑ �. :X---- Number will serve: Residence Apartment House Com�erclal Tr�er Court Motel �� 0 " Number of living units: _:1____ Number of bedrooms -::j--- Number of baths ___.___ Lot size= Water Supply; Public system �ommuriit s stem ❑ Private ❑ -Depth o'Water Table PP Y� Y Y Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay. Loam ❑ Clay ❑ Adobe "Hardpan ❑ T Previous Application Made: (if yes,dafie.-- No I' New Construction: Yes ❑ FHA/VA: Yes ❑ No [ � Prev pp - r 1 TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.] i lJ 4 -._ A ------- _ _O_p. -4--`----�-_-_-_•-_ - _-- on_1J__ .___. ---- Septic Tank: Distance from nearest well__.- �____-___-Distance fromM ;y,;.-_-_ k �' Liquid depth------ dd --------------Capaci No. of com artments__2-__ _ __.__Size_• ` - x# �} ¢ OGto nearest lot line_ ____ well Dar _e . Disposal Field: Distance from ea _ •nch7�- -`-------- _ h line--- ----- ofeac Number of lines filter mater!al_�.$_,__-,_______--Total length I�---D--------------•-- � Type of filter mateo -------__Depth of t a e Pit: Distance to nearest well__-_"'"_-____.. -.-Distance from foundation__111------------Distance to.nearest lot line"X-:-----•- �l Seep g r oG '3-t----------De th_... -�? - X Number of pits--_e°�_------------Lining material --- '�-: Size: Diameter--.- p _ {Y Cesspool: Distance from nearest well-------_----------Distance from foundation--------------------Lining materia4-------------------------------- ------ V) p •9 Size:"Diameter---------------------------------------Depth-----= - 'I li ----------------------------------- q i 9 --"`---- ---�:-------------- { Li bid -Ca acit ----------=---- gals. ❑ ` '......,. i,� ------- I_ --_,._-__.._Distance.,from;.nearest.bu!Idin G Privy: Distance from.nearest well----------------=------- - - -"' 1 ❑ ------=-------------------- --------------------------------------- Remodeling -- --}:.: .rest lot line_________________"--�-- - - Distance to ------------------- ------- --------------------•----------------f----=-•----------------------- -----•----------- f t Remodeling and/or repairing [ cfi!be) -----------------------•----------------------:--- •--------------4---------------------- i ------------------ ---------------------------------------------- t -----------------•-- -•---•------ -F _ ---------------------------- ------•--------•------------------------------------------ ----------- - I I hereby certify that I have prepared this application and that the work will be done in accordanceI with San Joaquin County I ordinances, State laws, and rules and regulations of the an Joaquin Local Health District ` 1 5 " . --------------------------------------- (Signed) --------------------- -{Owner and/or Contractor] (Signed)_ - �(? itl - -----------' ---------- - - ------- ----------------------------------i-------------- °----(T ,.,.�.ry ( [plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,.can" be placed on reverse side). , 5 FOR DEPARTMENT USE ONLY i a ! 4 .`� DATE: = ' r- APPLICATION ACCEPT! D BY- - ----------------- ------------------- �P---- 5 DATE------- -- •--------•: ` REVIEWEDBY---- ------------- ------------------------------- 1 -- BUILDING PERMIT ISSUED . ------------------------------- :----------- - DATE: --------------- - ----------------- ----------•-------------------- Alterations and/or recommendations:------------ q ---__----•-_--_-______.-" --------` ------------ -------- ------- ------------------------------------- - ;a , q I -------•------------ ...... ..-------------_______________________ -_._.-_...__.__ _ __________________ Date------------�'1--- -. FINAL INSPECTION BY---------------- -- -------- f SAN JOAQUIN LOCAL HEALTH DISTRICT I, 124 Sycamore Street 205 west 9th street 1601 E.Hazelton Ave. 300 west Oak Street 4 Manteca,California Tracy,California Stockton,California I Lodi,California ES 9 REVISED 8-59 3M 3-'63 F.P.CC.