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FOR OFFICE USE: ------------ y rfl�� ';� APPLICATION FOR SANITATION, PERMIT Permit No. -------------- ... ••-••--- 'rte--- - 1, 1:!3 (complete in Duplicate) Date Issued ---.-_-_---------------------- __-----_--_ 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 herein described. This application is made in compliance-with AAxo}} ut tY Ordinance No. 549. OIC,VZ�V__�m ------------------- ------------------------JOB ADDRESSAND LOCATION , Owner's Name-------- = 5 +- ------ Phone t�_T_ - ------------; r Address---=--------------------------- ..... ----------------------- ------------------------------------------------- C Contractor's Name..-------------- fl Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --.-t Number of bedrooms )r= Number of baths -------- Lot size _g-_c---------------------- --- Water Supply: Public system &K-6ommunity system ❑ Private ❑ Depth to Water Table f yft. + Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa ❑ Clay Loam ❑ Clay ❑ Adobe EgHardpan ❑ Previous Application Made: (If yes,date-------.--- --1 No New Construction: Yes 2-T�o ❑ FNA/VA: Yes ❑ No [fir. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) Sep^tic�T Distance from nearest well--' ----.__�_Distance from foundation__.,c9-{-.______.M�yaf rial__Vk.R_c_------------------_----..-___-- � L No. of compartments"---.-:-Z�__.__Size....,�1Cf_`1�--`�-------- Liquid depth----#_/a�—----------Capacity-_��------------ Disposal eld: Distance from nearest well------�.___-_Distance from foundation--- P__1____..Distance to nearest lot line_ ------- EY Number of lines]_.___:.:_: I_.------=-=-----'-Length of each line-----�-�-----�---------'width of french-----a-:'1t`--�--------------- � 1 Type of filter material___ _al---------------- of filter material--- _______________Total length___ -_ ---.----.-_---_---.---__--_. Seepage _it: Distance to nearest well------------------Distance rom foundation------��_�_.._Distance to nearest lot'line�-,--------- z Number of pits-_._..5---------------Lining material--�/k---. Size: Diameter___ _2_._I---_---€?epth_.�+.._ham_._______..- I S Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material__ -----._..._.-__------.-----_-----. G ❑ Size: Diameter_ ---------Depth---------------------------------------------------Liquid Capacity------------------------•--gals. Privy: Distance from nearest wefl------------------------------------------- g ------------------- ___Distance from nearest buildin ..................... ❑ Distance to nearest lot line------ ------------------------------------------- --------------------------------------------------------------------------- -- ---------- 7 Remodeling and/or repairing (describe):-------- ---- t`�' '�� G-------� ------- ------------------------------------------------------ 'f; -- ---------- { --------- ------------ ----- ----------------------------- ----- A ' --------------------- ------------ I ---------- --------------------------------------------- ------------------------------------------------------ ------- ---------------------------- ------------------------------------ --- ---------------------------------------------- ----------------------------------------------------------------------- ----------------------------------------------- I hereby certify that I have prepared.-Ais application and that the work will be done in accordance with San Joaquin County ordinances, State I , and ruI;caf regulations of the San Joaquin Local Health District. (Signed) ----------------------------------------------------------- --------•------------------ Owner and or Contractor'' ------- --- ---—----- L 7By:--------- ----------------------- E� +" " {Title) ��'.�'------------- ----- --------- NP (Plot plan, showing size of lot, n,of•system-in relation to wells,_buildings, etc., can be placed on reverse side). i 4 FOR DEPARTMENT USE.ONLY - APPLICATION ACCEPTED,BY_ !c. �(!_ :.-l--.-..-.._�v� _•- =y--------------------- - DATE S ff � t- ----------- REVIEWEDBY-------------------------------- - ---------- -------------- --------------- -------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------- -------------------------------------------------- --- ----- DATE------ ------------------------ --------------------------- Alterations and/or recommendations....._._'- -- �'-__- ------ . �l_. ` . -- . . ----------------------------------------- --------------------------------------------- ---------------J=--- -----------------------------. ------- ---------- - ---------------------------------------------------------- -------------------------------------------------------------------------------------------•------------------ ---- --------------------__----------------------- -----•---------------------------------------------------- -------------------------- - -------------- FINAL INSPECTION •BY:.. -----------/ -- -------------- Date-------`7-`.-_-_ -6s! -------------- 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 F.P.EO.