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``I`DR OFFICE U . I A6 76 e7 APPLICATION FOR SANITATION PERMIT Permit No. ..l.='��•��_�._ f (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. � 6 � anti JOB ADDRESS AND LOCATION------- ---'- ------7------64--- -5-'-�---�------7'------------------------------------------------------------------------------------------------- - -Owner's ------------------ ---------------- caner s .Name- ---- ' t+C.' . Phone. .. _ Address-------------------------•- = ._ fl --------------------------vo -- ------------- W.1 / f 1 Contractor's Name- --------- - ...... ------------------------------------------- ---••---•------------------------------- Phone---------------------��/ Installation will serve: Reside nce.`&9 Ap rtment.House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __}____. Number of bedrooms ---umber of baths _�__-__ Lot size .__��©_.._&�.�..�_____________________ Water Supply: Public system �. Community system ❑ Private E] Depth to Water Table4 _ ft. . Character of soil to a depth'V 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [jClay E] Adobe (A Hardpan ❑ Previous Application Made:.;{!f yes,date---------------------I No ® New Construction: Yes ❑ No �� FHA/VA: Yes ❑ No 2� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if.public sewer is available within 200 feet.) Septic Tank: Distance from nearest well:______________Distance from foundation................._..Material---.--------------------------------------------- ❑EVC154-IAII No' of compartments------ ------------------Size------------------------ -------Liquid depth--------------------------Capacity---------------------- Disposal Field: Distance from nearest well________________',Distance from foundation--------------------Distance to nearest lot line__________,_.-_ ❑ i$''l1JNumber'�of lines-----------------------------------!Length of each line------------------------------Width of french----------------------------------- Type ------------ ---_Type of='filter material----•-------------------!,Depth of filter material.--------------------_Total length-------•----•----:---••--•.--------- -•__-- ® � p' ��_____Lining material_ t?_C%.K--_- St'on---f!!�_.....___.Dis��nce to nearest lot line�_�. _______. \�, ,vg V SeepagePit: Numberk f ntsr- -well---.____Lining __Distend from foundaze: Diameter_,�3__._---.__-Depth_. ...-.•_______ ______ Cesspool: Distance from nearest well____.__° t_:Dis once from foundation---____---___--_.Lining material-_.______________________________.. Size: Diameter----------------------------= __D`e't El l 4 fDi . Liquid Capacity Sols. ❑ p . ------ ----- , Privy: Distance`from,nearest well..;-�-_- ---.-F -_-- -� stance from nearest building--_________________________________ Distance`to nearest lot line---- = -----•-- f-----------• --------- --------------- Elm > = � � - �- _ Remodeling and/or repairing (doscribe):------- -- n--- r'' .l 10----...--•---- ---•-- 1-=1--------•---^---------------- ------------------------------- ---------=--- ! �!°--- tZN,_ 1 t.' r .�k. . -�., --------------------------------------- '-------_---------------•---•---------•-•------ ................_......._..._. -------------------------- �� R r- ------- I hereby certify'that I have prepared this application and that the work will'be done in accordance with San Joaquin County ordinances, State la s, err :'`rules and re Mations of the San Joaquin Local Health District. P - R 6 Owner and/or Contractor (Signed) ��:.�i. _ -r .C- '--------- -- ---------------------------------- -- [ / ] �/ } _ i A/.�10...t_Ap,j. k e . f t! t ; Ti+le f Y r—:P A t- By:.. ------:�---:---- t - - ---•-------_---- ---- ---- [ ) -- - [Plot plan,`showing size of Itlocation of system inrelation`to'wells, buildings, etc., can be placed'on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED%BY--- r -- "� ------ DATE------- �� f................... ------ DATE- REVIEWED BY------------------ ------------ ---- -�---------------------------------------------------- ----------------- ---------------.._--------- -•-•------------------------- BUILDING PERMIT ISSUED --------- ----------------- --- -- `' i -------------------- ------------ ------------------------ DATE---------------------•--•------------------------------------ Alterat'o and/ r recommendations:__ ---------------- - •-------•--------•------- ---------- ---------- ------ --------- ------� _ - /. --------- ---- - ate = j � ...... eFeM = ......__..._C ! _ F ._ ; ----------------------------------------------------------- ----------------------------------------------- -------- ----------- --' !� t FINAL 1NSPECTlON BY:�. -1---------------------- Date__ . f - �i ! SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California I Lodi,California Manteca,California Tracy,California ES-9 REVISED 8-59 F.P.CD.ZM 6-SD