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FOR OFFICE-___, l'✓-ar' n 1n s 4y / �7� APPLICATION FOR SANITATION PERMIT Permit No. ._J_.�Q..S> 5. .. - ------------------------------------------ - (Complete in Duplicate) Date Issued ______________________-..-.---..-.-_-..---..---.--._ This permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN LOCATION----- _3 1 L,.'�` L -•------------ Owner's Name------- d ` � SL;,fus&t ------------ L -Lt - Phone t4F.lr _ Address ---------•------------- ----------------------------------•------ --------------------------------------------------•--------------------------------------------------- Contractor's Name----------------------------- ---•--••------------ ----------------- --- -•----------1-- '� --------------- Phone Installation will serve: Residence>k,Apa'rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j-.. Number of bedrooms 43... Number of baths 1-yLot size ----- Community systemX Private ❑ Depth to Water Table -------- ft. Water Supply: Public system III Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay E❑ Adobe,(Hardpan ❑ Previous Application Made: (If yes,date__6--�------) No ❑ New Construction: Yes &,No ❑ FHA/VA: Yesk, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �f��, , Septic Tank: Distance from nearest well ---- --Distance from foundation--- ____._.Material-__—!'�--- ` .--. xNo. of compartments___.__.______.:_Size_--_2K'?.y.----_—SLi uid de tk------_t-.^ .Capacity �__ Disposal Field: Distance from nearest Distance from foundation-----.104'__.Distance to nearest lot line_---- Number'of lines-----------_�______ __________Length of each line------- __ -----------Width of french 7-44 Type of filter material- - Qepth of filter material-----------` ____.Total length___________________��-_ ------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation_:___-____.---_--.Distance to nearest lot line----------------- .r F E1 Number of pits-------------_-------Lining material---------- ------------Size: Diameter-------------- --------Deptn ---------- ------ Cesspool. Distance from nearest well-----------------Distance from foundation...........--------Lining material------._..----._----------_.--___---_. �b Size: Diameter------- ------------------------------De th----------------------------------------------------Liquid Capacity gals. 7 Privy: Distance from nearest well-----------------------------------"---._.___=_Distance from{nearest building----------------------------------------- ❑ Distance to nearest lot line------------------------------------------=_---------------------------------------------------------------------------------- ------------ Remodeling and/or repairing (describe)---------------- ---------------------------------------------------------=•--------------------------------------------------- .. V.s .( i -----------------------------•----------------------------------------------------------------•------------•----•--------------------------•---=------------------------------ -------------------------------------------- I hereby ce if that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e laws, ano rules and regulations of the San Joaquin Local,Health District. 1 _ (Signed) G_ �LL -.- _____-_---_Owner and/or Contractor J By•----------------------------------------------------------- ---------------------------------------------------------------------(Title)--------------------------- (Plot plarr'showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -------------'-------------------------------------------------------------- DATE---------f REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-------------------------------•-- BUILDING PERMIT ISSUED-------------------- - ----------- ------------------ D TE.--- Alterations and/or recommen ations:--- __ __._-- -- .:� 'n/ _ ..__ .._._ 12__� Oations: ---- -��-�-- - --- . . '-'Tit� ----d>t = 'l -r-» t'-" ' -- - -------- _ .--------------- FINAL INSPECTION BY-----------------------------------------------•-------- ------- Date---------------------------------------- --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hosellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California CS 9 REVISED 5-59 3M 3-'63 F.P.CO. f