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w / -7 APPLICATION FOR SANITATION PERMIT Permit No. _f.G/- _-/_.-.- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------- 1�I + North' Sargent---------------- _- '--------------_ _ -------------.- Darwin Colb - 1 .- ... - ---- Phone------------------------------------ Address '------- ------ Owner's Name--------------------- •-------------------•----- -�------_---------------------- --- --- ------ -- --- •--------- Address - --------------------------11.29 Sons. WaY------------------------------------------ -- ----------------------------•------------------------------------ Farrish� ' k° e xob-�6o� Contractor's Name -------- --------------------------------- ------------------------------ Phon w Installation will serve: Residence [ Apartment House ❑ Corrimercial ❑ Trailer Court�C] Motels E] Other [ t ; t t �. Number of living units: --- --- Number of bedrooms __3___ Number of baths __2_ Lot size ______602O 'i f - Y r. t .. Water Supply: Public system [T Com unity'system'❑' Private F1 �;Depth'to'Water Table 1_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel L❑ Sandy Loami[❑ Clay Loam ❑ Clay El Adobe[2. Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction:;.Yes ❑ No Fr] FHA/VA: Yes ❑ No Ek TYPE OF INSALLATION AND SPECIFICATIONS: f F a ( p P p Xibn@ ,within- feet.) t Septic Tank: Distance from nearest well--tiorie D'Distanc from r No septic tank or`cess ool permitted if public sewer is available p foundation----'�-----_:----. aterial------Cc-brick ' 2 bx 6 _Li uid:.de th__ 000---------- No. of compartments__________________________Size__--_. _ i 1. .. Disposal Field: Distance from nearest well------___.______Distance from foundation__.-- "___!_--_.Distance to nearest lot line------------- Ea ting Number of lines._ ----- - -----=Length of each line.................................Width of trench---------------.--.---------------- Type of filter,mate'riel_-----------------------{-Depth of filter material.------- --•--- -----Total length-----------------.....-.------------------ Number of its_r_T_':- - __L�i�n`in material-- -___�_�__ Seepage Pit: Distance to nearest eIL_____________ __ foundation_____________:_.___.Distance to nearest lot line___________._____ : p i � g Distance .from '___Size: Exiting .. -- -=---Size: Diameter----------------------Dept h-----------------------•--------- Cesspool: Distance from nearest well_:_.___-__„___-_Distance from foundation-'-__.___---_.___.Cin'sn.g material_______________________.'_.____ ❑ Size: Diameter------- ---------------- Privy; ----- ----- Depth :_ -- Liquid Capacity gals. Privy: Distance, from rearest well--------.---------------_-------------•-----------Distance from nearest building------------____________________________- ❑ Distance to nearest-lot.,-line_-:__ - ----- ----------------- R `^ --'” Remodeling and/or repairing {describe):,--------- --- xi.Sting---redwood---tank._that.--has---caue_d---in..._. Fill-_exist- ng-,tank-------=------D/ °- ---------5Ay_5--------ZA17PKMA�N-_-------�`y_,6 -- -- ---------------- X%_V -_-•.-- ---------FU_NCr1_0N_!N_0_--------- 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, and rules and regulations of-the San'Joaquin Local Health.District. (Si ned ' ` . ------------- --------- --- (Owner and/or Contrac ~ Plot Ian, showingsize lot, ocatoniof system in relation�to wells, building--- - --------�-(Title__________________ESt�-__.:____..__.._._--_-_----- --- By: -- (Plot g f by s, etc., can be placed on reverse side). --t FOR DEPARTMENT USE ONLY " APPLICATION ACCEPTED BY ----' ----------------------------------------------------- DATE-- 3_70 -57---------- ._--------------- REVIEWED BY 'Ka. DATE----------- ------------------ - - ----- BUILDINGPERMIT ISSUED----------•------------------------------- ---------------------+-------------------=--=--------------- DATE------------------------------------------------------------- Alterationsand/or recommendations--------------------------------=----------- -----------------------------------------------------•-------------------------------•.-----•------•-----------.-- --------------------------------------------------•------------ -------------- ------ -------- -----------------•-------------- • {/--••--------------------------------------- ------------------ ------Q, - �-- � ------- ar- ---------�Fc_c�_nl_V_ . T�� ------} .._... F �l�!�. i _S N._ �"" L-- -1 ........ _PT#- -------------Q_,_ ............. TA _ ----------------------------------------------------- --------------- FINAL INSPECTIO BY:- - - TI2 ----- Date------ = /// -------- - -------------------------------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef Stockton, California Lodi, California Mantecg,.California Tracy, California ES-9-2M , Revisea 1-57 F.P.CO. r