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FOR OFFICE USE: --------------------------------------------------------- 417 APPLICATION FOR SANITATION PERMIT Permit No. .1•?7..... (Complete in Duplicate) Date Issued This Permit Expires I Year From Date Issued I�---T..:___ 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 Ordina 9.- JOB ADDRESS AND LOCATION.---- � ------- ------C 1 -`----------------------------------- 1 A_lv -C Owner's Name------------ � RO -------•- I- �_ T --------------------------------------------------------------------- Phone------------ ----------------------- Address----------------11,6-------&0--------- -------5f1-----------------47 --------------------------------------------• - - --•------------ F - Contractors Name---------- ----f�_2-:�•��_-_.------�------- ------------ ---------------------------------------------------------------- ------ Phone.. --------- -------------------•• l� Installation will serve: Residence ®''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.1___ Number of bedrooms Z.- Number of baths 2—Lot size ----A. MO—_._4�-----_f-.____________.__._ Water Supply: Public system ❑ Co�munity system ❑ Private r❑--6epth to Water Table /0_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,date--------------------) No Z----New Construction: Yes kj"_N_o ❑ FHA/VA: Yes t' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic nk: Distance from nearest well___ - ---- Dista ce�f/roIm founddation_/O_______.__.Mat ri I__ e["Z C'T- _ -_ Sep No. of-compartments__.__.2 Si ' __[_!�f X_5Liquid depth__.____..Capacify_./aQ___ � - r Disposal_Field: Distance from nearest well_-- G __-_Distance from foundation----/(�_-------Distance to nearest lot line__>}__________ .- B111 Number of lines-------------�—___.--------Length of each line+_� _#__�/. Width of trench_____36- _.____- —____._ Type of filter material__1R!6_(C .___Depth of filter material____. g r-f----Total length i Seepage Pit: Distance to nearest welt----- _----- 8----Distance from foundation____-------_-------.Distance to nearest lot line..____.._________ ❑ Number of pits----------------------Lining material------.--- ------------Size: Diameter.----------------------Depth--------------------------------- Cesspool: Distance from-nearest Well-----------------Distance from foundation___--_— ___-=_-lining material__._.________.__________.______-__--_. ❑ Size: Diameter--------------------- ----------------Depth------------------i------------------------------ _.Liquid Capacity----------------------------gals. Privy: Distance from nearest well-._.___-.__._.____________________________ Distance from nearest building-----.----------------------------------- . ❑ Distance to nearest lot line.R_�d,-,.,.e�.c.w. .� --------------------------------- ------------------------------------------ --------------- - Remodelingand/or repaiting (describe):-- ----------------- ----------- --- -------------------------------------•------------------- ------ ---------------------------------- -•---- i. I ----------•-------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i ____________------------------------__i-____________________-_._____-_______-__.__-_-_____________-_ r . ____________________________________ ______________________________________________________________________________________________________________________________________________________________________________________ I hereby certify that l 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., _Zj (Signed)__.______4 . - _ --------------------------- ______________________(Owner and/or Contractor) .� By:-=--------------------------------------------------------_- T LL - = - `,.. _` =(Title) - =_- - - _ ." ` --- _' :"-- _. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY C (D APPLICATION ACCEPTED BY--- ./_..!_ -.. R-_�r�_---;------------------------- -- ---------------------------------------- DATE-------f�� ~-� (D APPLICATION kA REVIEWEDBY------------------------------------- ----- -- ---- -------------------------- ------- -------------------------------- ---- DATE_--------- ------ \A BUILDING PERMIT ISSUED-----------------I------ -- - DATE-----------------------n-------------- --------------------- Alterations ----- Aiterations and/or recommendations:.}------------_--------------- -------------------------------- '----------------------•--- --------------------------------------------------------------------- i i --------- ---------------------------- ---- ----------------- -------- ---------- -------- ---------- --------------------------------- - ----•-----------------------------_:-__-_-1_1_1--------------------------- ----------------- ------------ --------- ---- ------------ ------------I------------------------ - FINAL INSPEC-T-I - Date------------ ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasolton Ava. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.0 O.