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F R OFFICE USE: ---- --- . -�-7 "f Permit No. ... " 00 APPLICATION FOR SANITATION PERMIT ------------C-- / � �-- (Complete in Duplicate) pate Issued � " - �This Permit Expires t Year From Date Issued ; --- =--- - -------- -------- Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local This application is made in compliance;with County Ordinance No. 549. --- ---- --------------------- JOB ADDRESS AN LOCATION__.____: !_. - -----/" Phone------------------------------------ Owner's Name_______ _---_1�:---- r _ - / G�' := -- r-----..... Address------------------------- - l- amu Phone l--d--`�------ ----- ---- --- -- - ---------------------------------- C ____________ •-..----' - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J--- Number of bedrooms,3- ---- Number of bat -/,2,Lot size _/61V ------------------------- Water Supply: Public system ❑ Community system ❑ . Private 2``Dpth to Water Table �0ft. Character of soil to a depth of 3 feet: i Sand ❑ Gravel F1Sandy Loam ❑ Clay f oani El Clay C1 Adobe Hard [+ � ..---) No ❑' New Construction: Yes [ X10 ❑ FHA/VA: Yes E3 No Previous Application Made: {1f yes,date-----_________ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t # Distance from foundation ----MatgriaL_ -_/3CL.� 5epfiic T Distance from nearest well_ --- Capacity-J.b No. of compartmenfs---- ---------------Size r . --x�b-LiGu'd depth_----------- ----- I G I Z. 1 Disposal ' d: Distance from nearest well._. "._.._Distance from foundation__ _______________Distance to nearest lot;ine___ Number of lines-____-- Length of each line-------------.--------f-------.Width of trench_____ ----.- ------------------- �c1lDe th of filter materiaL___�_ -.-----�-.Total length---.__,/-57Z J f Type of filter ma teriaL__1_��- P �{ Distance to nearest well....�- -.-°Distance m foundation---/.�.__.__..Distance to nearest lot line__-._____ Seepage Size:'Diameter_-1_ --------------Depth ---• ' �----__-_--Lining material_ [_ `�- P -- - �?�- --- � Ei/ Number of pifis- I- - _ W Cesspool: Distance from nearest well_________________Distance from foundation_____.___,-______-.Lining material____._.__________-----------"-gals. ----Depth--------------------------------------------------- El -------- --- Liquid Capacity ❑ Size: Diameter---'k -------------------- [ 'Distance from nearest well------------------------------------------------Distance from nearest building------------------------------_________-_ Privy: --- ---------------- ❑ Distance to nearest lot ine------------------ , - ------------------ --- - Remodeling and/or' repairing (describe):------- 'f-� '�-'G`----- ' '! Al -----------------------------------------------------------••-------------- --------------------------------------------- � ' = F..- ----------- k ------------------------------ - y _________________._______-___ ___�- - �x ________________________-____-__-- ---________--__ that e work done ordinances.hereby certify ify thaa I havesparidared d7lthis ati ns olication f the Sant Joaquin hl-cal HealtheDitr District. accordance with San Joaquin County ate i s (Own and/or Contractor] �--; (Ow d/o (Signed) (Title) --------- By:-------------- ----------- ) �l. (Plot Ian, showing size f 1 t, location of system in,relati trio wells, buildings, etc., can be placed on reverse side). I ( P .t .FOR DEPARTMENT USE ONLY 1 (a` --------------------------- --- - -------------------------- DATE 4 ' (° APPLICATION`ACCEPTED"BY_'_C-+ F ={ DATE-------------------"---- i REVIEWED BY------------------- `-i s _. - � J i ---------- ----- DATE.---- --------------------- --- - ---------- BUILDING PERMIT ISSUED ;.; s ina . � �.- s--------------- - �---------A- -=----- Alterations and/or recommendations:___ .�-o_ -.- -------- ------- ------•----------"•--------•-----•--------------- 1 ) ----- ------1• .- . r----------- ------------------------------------- ------------------------------- ---------------------- Date -r -------- FINAL INSPECTION BY:------ ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3oo west Oak Street 124 Sycamore Street 205 West 9th Street t Lodi,California Manteca,California Tracy,California Stockton,California t ES 9 REVISED 9-59 3M 3•'63 F.P.CO.