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rc.�lzc�rrlct ust: F ^: -.--.--_---------------- -- - ---------- --II.- APPLICATION FOR SANITATION PERMIT Permit No. - 7 1- (Complete in Duplicate) l: 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. I This application is made in compliance with County Ordinance No. 549. ,+ JOB ADDRESS AND. LOCATION-763---- --- - %+ _ ill Owner's Name_____ Phone ` _ _® 3 Address .l --I------- ------- ® ------------ -------- - - ' Contractor's Name____ - ,�� _ -- ----- Phone--az- - +�—__)__�T. _ Installation will serve:: Reside Is ® Apartment House ❑ Commercial 0 _Trailer Court ❑ Motel ❑ Other ❑ �1 Number of living units;__.'__ Number o bedrooms__.____ Number of haths _____._ Lot.siz��._x__�2a-__- f=�� 1�5__ __...____ � I u 4+ w Water Supply: Public system! ' Commuriity system s Private ElDeptl"to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand, Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe ❑ Hardpan Previous Appli,6ation Made: (If yes,date- _J No' ] New Const ruction:'Yes�` No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 3 ,� . (No septic tank or cesspool permitted if public sewer is available witE�in 200 feet.) � :Materia� _�C-��.�__� ________ Se tic Tank: Distance from nearest well_f��______Distance from foundation•__; p _ _ . - No. of co�partments____�...-----------'--Size-------------------------�-_---Liquid,_depth'—,__.'.----------+Capacity__-' -�� _ Disposal Field Distance from nearest wef#.I/�-572�._.D.istance from fouaat:i _ �5/--------Distance to Barest lot line_ 14____r___ Number of lines________-�... length. of Bach'IineW__:�...... �t/Vidth of trench__4�f __ ------_------_______ Type of filter material ��- -C�_c __Depih hof"filter,material.._�_ _`-_______Total'"length________________________--____________ Seepage Pit: Distance to nearest ,,ell,J.`!d----___ Distance fromifoundation_____ _ ' �`�� / Number of pits._-__,_________-__Lining material_/_ ___,= _ 'Size: Diam ern?�& '¢/._t-6epthst lot -ine__.�-�___--_ Cesspool: Distance'fi•om"nearest we'll-----------------_ Distance from foundation................... Lining1material--------..-__..____-________.____..__. a ❑ Size: Diameter.- -`------------ -----1�y='-'--'.Depth`^ --�� ------------Liquid+Capacity----------------------------gals. Privy: Distance from nearest well --- T _:______,__ ,„.�___.....__�.._._Distance from nearest b ilding______________________________.____-__. ❑ Distance to nearest lot line________________ •'-- + .----.------. Remodelingarld/or cepa ing”(describe):--------- ----------------------- ----------------------------- -----------J---------------- = ---------------•------------------------------- ------ ----- - -- ------ ----- ------- ---- -------- ------------- - - -----=---------------------------- --- -------!--------------------------------------------------------------------------------------- ----- ----------------- - --------------------------------- -------------- -- ------------------------ ----------- " ' ` ----- I I hereby certify that I have prepared this application and-that the work will be done in accordance with San Joaquin County ordinances, State ws, and runes and regulations of the San Joaquin..Local Health District. (Signed) r - __._____._7__ - - ---------------------------- ---------- --------------------- ---------.(Owner and/or Contractor Iii. By:------ i- --------------------- -------------------------------------------------------------------------------------------------(Title)-- ------------------------------ ----- - - (Plot plan, showing size of lot,l�location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATIONILAC'CEPTED BY �4- _ DATE_- =-5�___ -----------'--------, t ,,, , �� { --------- ------- '--------------- REVIEWED BY '� ," -- DATE BUILDING PERMIT ISSUED----(1---------------------------------- ----------- ' ``w --------------------- DATE - I Alterations and/or recommendations______________ _ -----�- --------------- -------------------- .------------------------- -----' --- ----------------------------'-- --------------------------------- !- • I FINAL INSPECTION BY _ `/_______ Date___ �� G ? Vo SAN JOA UIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California I F.P.CO. I E