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+ON FCR SANITATION PERMIT Permit No. .___!__ ............. APPLICA (domplete in Duplicate) }� Date Issued Application is hereby made to the San Joaquin dtHea( istrict for a permit to construct and in tall the work herein described. This application is made in compliance wit ounty Ot'din ante No. 549.E µp f • JOB ADDRESS AND4LOATION-- �,�-a�: �f:'- -- / "t"Y�----- --- �Owner's Name --------- - ------ Phone--------------------••-------------- - --- - - - t Address_..._ !f - ------•-•------------••---------•----•------••-•-----------•- Contractor's Name------K� ' �G--- -- --- �t �/ R Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I_--- Number of bedrooms. Number of baths A-- Lot size —--------------------- Water Supply: Public system E] Community system rivate C-] Depthto Water Table4t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam�] ay Loam ❑ Clay ❑ Adobe❑ Hardpan 01F�\ Previous Application Made: Yes ❑ No ?`G New Construction: Yes to ❑ FHA/VA: Yes fo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) e, /A Septic Tank: `mance from nearest well)l}�'F-Distance from foundation__/e-.____--Material---S.c!__Y ___ __,_�. No. of compartments-- -------------- ----Liquid depth---- ��- ---------Capacity--- ---� bisposal Field: Distance from Weare t we Distance from foundation_____°----------Distance to nearest lot line__.__________ ®� s Number of lines___ elf ______ ____�-ength of each line__ _a _�______� __.Width of french------ ____._____-___ Type of filter material_1�t A-,Depth of filter material----lAe---__----Total length______ _, -----__________--__� Seepage Pit: Distance to nearest well______ -&'Nstance from fou ation _.. __.Distance to nearest lot line____ .__-__ - ®t Number of pit,--------e_----------Lining material/��Size: Diameter_S.0-4ee--.---.Depth__._- _____'_______-_ Y Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material__.-_______________.___________--___ ❑ Size: Diameter-------------------------- ------ ----Depth_---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------- -----. . ❑ Distance to nearest lot kne----------------------------- ------------ ------------------------------ Remodeling and/or repairing (describe):-------- -- - - ---- - --- --------------------------------------•------•-----------------•-------------------------------------•--------------------------- --------------------------------•--------------------------•------ ;--------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ---------------------------------•-------------------------------•----------------------------------------------------------- .._-_.------------------------------ 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, an�djules and regulations of the San Joaquin Lo I Health District. (Signed)------------------ -- ------ /L 44w+�er�T►dfar Contractor By:-------------------------------------- ----- ------- - ------------------------------•--- ------------------ - ry (Plot plan, showing size of lot, to on of system in relation to wells, buildings, etc., can be pla`cea on never side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------=------- ---------------------I----------------------- DATE------------ REVIEWED BY - .s_.,..r- DATE - y BUILDINGPERMIT ISSUED------------------------------'-------------------------------•--0--------------------------------- DATE.--------------•--------------------------------------------- Alterationsand/or recommendations:----------------------------------------------------------•-------------------•-----------•----------------•-•-•------------------------------------------- ----------------------------------------------------•------------ --------------------------------------------------------------------------------------------------------•-------.-----------------------•------------------ -----------------------------------------------------------------------------------------------------------------------------------------------•----•------------•---------•------------------------------------------------ ----------•---------------- -•-------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------- FINAL INSPECTION BY---------------- --------- ----- Date-------� -7-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9---2M , Revised 1-57 F.P.CO.