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FOR OFFICE USE: - ------------------------------/------ --_----- APPLICATION FO SANITATE4N PERMIT Permit No. Z.77&F3---._ ------ --- --------------------- - (Compl6te"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 4madeompliance with Cou y Ordinance No. 549.JOB ADDRESSTION �.. - ------------------------Owner's Name --- Pho ------------ Address-----i------------------ ----- --------------�---`--------- �__.-..- -------- ---- --------.--_.-P�------------ s ., le Contractor's Name .l..c._i. C -'�7 -------------------------------------------- ---------------•-------- -------------- one ------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑$'aFP Number of living units: -- -- N ber of bedrooms __!'- Number of baths ---Z_ Lot size __-- � .� �. I t Water Supply: Public system Community system ElPrivatpth to Water Table ' t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ A obe Hardpan E]Previous Application Made: llf yes,date.----- ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted-if public sewer is available within 200 feet.)=- Se T _77 istance from nearest well-------------_-Distance from foundation--------------------Material--------------._-----..------------.-- -----. No. of compartments______________ --._..-.--5ize-_--_---._____-._.__-_.-.C--__-_Liqui�-�pth------------- Distance to nearest lot line---�_--A S Distance from near st well__�4? istance from foundation---- r .--.Width of french_�� Number of lines----- -- Length of each line.... �"---_.------ Y_j_-----.-_ Type of filter materia ---- - -�l .__Depth of material--:_.- --- _�-".---Total length-____---__- - - - Seepage Pit: Distance to nearest well--�Ta---__ Distanc�1.*cJAZ,,_1_,Size: om'foundation---- ` -�-_-..Distance to nearest I line__-_-._ z Number of pits------�--- ----------Lining material-- Diameter----- ��---Dept``- V Cesspool: Distance from nearest well-----------------Distance from foundation._..----------------Lining material_-__-------------- 9 ❑ Size: Diameter--------------------------------------MPA----------- -------- --;:------ Liquid Capacity--------------------------- gals. 7 Privy: Distance from nearest well --------------- -----__,--------------_-.- _Distance from nearest building_----_-----___-.___._.._-.- fiDistance to nearest lo.fi�line--------------------------z-__---------.----::--._------------------------------------------------------------------------------ -- ------------ Remodeling -- ----- Remodelingand/or repairing (describe):-_---------------- ----------- -------------------------------------------------------------- ---------------•----------------------•------------ -------------------------------------------------=------------- ---------------=--------------------------=--------------------------------•----------------- -------------------------------------------------------------- tl ------------------- ---------------------------------•-------- -•---------•-------------------------•--- ----------------.--------------------------- -----------------------------••--------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfate laws, and rules and regulations of the San Joaquin Local Health District. (Signe ' � rJ y�p- --------- n or Contractor) fg (Title) ---------------------- - - --------------- - (Plot plan, showing size of lot, location of system in relation t wells, .buildings, tc., can be placed ori reverse side). FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BY-.- ------ -------- --------------------------- DATE _-/--------------------------- REVIEWEDBY-------------------------------------------------------- ------------------ ---------------------------------------- DATE----- ------------------------------------- BUILDING PERMIT ISSUED--------------------- DATE-------' ------------------------------------------------ -- Alterations and/or recommendations: -----1/ ----- �1�-.r... „r..--•--•------------------------------------ -------------------------------------------------------------•---------------- ------------------------------------------------------•-•--------------------------------•---------------------------------------------------- ------------------------------------------------------------------------------ •------------•---------•---------------------------------••-----------------------•-------•------------------------------- ---------------- - -------------------- FINAL INSPECTION $Y:- ,, .----------- ------- ---- --•---- --- Date--------------------- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street _..n 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CO.