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FOFFICE USE: _. --------------A / Permit No. APPLICATION 1=0R SANITATION PERMIT , - - ---------------------------- ---------------- (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 County Ordinance No. 549. JOB ADDRESS AND LOCATION --:---='`a--`---C7-`7----------= 4 ,, ------- ------------------------------------------------ -------� Owner's Name------••- _-.-- ----------- ------------------ -�- - -�- r-21- , Address.......---- - ..-..----•----------------------------------------------------------------------------•-------------•---•----•------------------------------ W Contractor's Name-------- C -fir �f------ =------------------------------------------------- ------------ Phone,4,r E>�7----- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: __ Number of bedrooms _j*77_ Number of baths __1-_ Lot size __7S_'...X/4.0.'------------------------- Water Supply: Public system 2 Community system ❑ Private ❑ - Depth to Water Table /.20 ft. Character of soil to a depth':of 3 feet: ,Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay t' Adobe❑ Hardpan ❑ Previous Application Made. :(If yes,date-------__._.._._..__.) No New Construction. Yes ❑ NoX FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: [` (No septic tank or cesspool permitted if public sewer.iis available within 200 feet.) µi Septic,Tank: Distance',from nearest well-________________Distance from foundation--------------------Material------.--------.---------------------------------- [] No. of compartments--------------------------Size---------------------------------Liquid depth.-------------------------Capacity------------ ------ Disposal Field: Distance.from nearest well -Distance from foundation----14�2--------.Distance to nearest lot line___,-----__--- ; I Number of lines-------------- Length of each line--------1- - .......... of french----------- ----------- -- t ] Type of filter,material-._,fE _:Cr/_Depth of filter material_-__-_jam_"_._Total length------------------- �=__ -------- fff - (� Seepage Pit,: Distance� ___ ito nearest well_ __2��['_-Distance from foundation_ h _____ __, :__ �._..Distance to nearest lot.line__ _ ._._._ I ' Number'of pets_------1.----------Lining mate ° � ---Size: Diameter----•---; Depth------------3 � lI - CesspoolDistance"'from neareswell-----------------Distance from J foundation material--.----_-_____.-__________#______.___ ❑ Size: Diameter------ '-------------------------=---Depth--------------------- -----------------------------Liquid Capacity-------:--------------- ---gals. Privy: Distance:y.from-near� - - st..well--------------___ ___________________.____.____Distance_from 'nearest building------------------------------_----------- ❑ Distanceto nearest lot line.- -- --------=------- --------------------• --- -- -'--------- - -- ----- � ---------------------------- ---------- G Q Remodeling and/or repairing (describe}:---------.__.�-_�_� W.____._.__ ---------------- ---- ------------ ---------------- ----------- ---------------- - ------ -------=--------------------------- ----- ----------------------- th- ------------------------------------------------ ----- --------------------------------- --- --- ----- -------------------- - I hereby certify that I have ;prepared this application and that the work will be done in accordance with San Joaquin County iordinances, State laws, and rules and tPegulations of the San Joaquin Local Health District. r t �{ ner and/or Con r actor)`-- ------- ---((Signed)BY: �:'-t/lz.c �- -- - - - -- ----(Title)----- _ ----- ---- --- ----------------- (Plot.plan, showing size of lot, locafiodb f system.i relation to wells, buildings, etc.; can be placed.vn reverse side). FOR.DEPARTMENT USE ONLY t APPLICATION ACCEPTEDiBY--- c -fir DATE s "�~ --------------- REVIEWED BY---------------------- - �, II -- -- ----------------- - ---------------------------------------------- DATE----- ----------- - t BUILDING PERMIT ISSUED:' I k Q t - rt .----- DATE---= k --------------- 2- Alterations and/or recommendations: t — " �`� �f � i�:-_. 1''` 'J`''� �``sT°` ------/01-------�=-r h ------------------------- i! 7't• ,�� c �L-C'`. t� ------1---------------/--/------------------/-- -------------------------------- ------- -------- --- -- i --- ---------------- --------------------- - FINALINSPECTION BY--i---- ---- - ---- ------ --------------------- - Date------- --,-- ------ •-------- -------- ---- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. q 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California !� Lodi,California Manteca,California Tracy,California ES 9 REVISED 9.59 3NI F.P.C.. n Jr .: