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FOiZ OFFICE USE: _______________________________________._..________._.. APPLICATI%4, _,<__._ POR SANITATION PERMIT Permit No./_ 2-_-_._.. ---------------- -------------------•-------------------- (C1;mplete in Duplicate) .� ---------------------------------------------------=----- This Permit Exp'ices 1 Year From Date Issued Date Issued .____ __s__ 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. JOB ADDRESS AND LOCATION-..3_7'__3__K.... KC_ �_ -----=Q-- ------------------------------------------------------------------- •--------------------------- Owner's Name_ Q._ ; "�'-�------C ------------------------- Phone-------•---•---•----•----•-•----•--- Address------- '3 5 ~ JG>'{ - 3 -- I Contractor's Name---- l S -------•-------g------------------------ ------------------------------------ ----------------- Phone_-------•---- ------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑p�Motel ❑ Other ❑ Number of living units: ___-I___ Number of bedrooms 4--- Number of baths OZ-, Lot size .._�?.� 3-2.7� __-_______________ Water Supply: Public system ❑ Community system ❑ Private EJ`Depth to Water Table'!�-5ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er Hardpan ❑ f � Previous Application Made: {If yes,date--- -----_,--------l No New Construction: Yes 2rNo ❑ FHA/VA: Yes ❑ No K3--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) I - or Septic Tank: Distance from nearest well_4_�---_---- Distance from foundation__I-0____________Material____! '_" " v No. of compartments-------Z____________ 'Size.__ _ _°/X_t�`_____Liquid depth_w-_.'d__-._____._-______Capacity_1:�o Disposal Field: Distance from nearest well__.4'_4_f----ADistance from.foundation___�� ------__Distance to nearest lot line----------------- �I E f Number of lines----- --�--------------------!Length of=each line_/aa�---r__ Q----.Width ' trench-_� --------------------- Type of filter ma.terial =_rLo� _______'Dept.h of filter'material___ _Total length----/S2__e______________ ----------- Seepage.Pit: Distance to nearest well__'©Q__r_______rDista rom foundation___�6._�_'`__. Qistance to nearesfi lot line___ - `! [ Number of pits____' _____________Lining material____ ___..Size: Diameter13�_..___________ Depth__AT-------------------- Cesspool: ______.__._____ -- Cesspool: Distance from nearest well---------------'_Distance from foundation--------------------Lining material------------------------------------- l i ❑ Size: Diameter--------------------------------------De th-------'------------- ----------------- --- -- --Liquid Capacity----------------------------gals. IL. Privy: Distance from nearest_well------- --_---------------Distance from nearest building--------._--__.__________i_____.______._. I, ❑ Distance to nearest lot line---------__------------------------------------- Remodeling and/or repairing (describe)_______________________ ------•--•--•--••---------- t, ----------------------------- ----------------------------------- ----------•------------------ ---------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------- ------------- 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 laws, and rules and regulations of the San Joaquin Local Health District. -----'- -------- ------- /- _...- - ---- (Signed)-------------------- --- --- ---- - - - -' -------------------------------------(Owner and/or Contractor) By---------------- � LGz'i__---------- Ti#le--------- I ' ( ) ` ----------- --------------- - -L (Plat plan, showing size of lot, location of system in relation to wells,.buildings, etc., can be placed on reverse side). �✓ FOR DEPARTMENT USE ONLY r f APPLICATION ACCEPTED BY------------------------------------- --r--------------------------------------- DATE REVIEWED BY --------------------.---------------------------------- DATE --- ------'-- ... BUILDING PERMIT ISSUED------------------------------------ --------- ---------------------------.- ------------ DATE- o - ------------------ Alterations and/or recommendations:._____ te_ - -------------------------------------------------------• ------- --------------- -------- --------------------- - •-------------------------- •------.... FINAL INSPECTION BY:_---- --------------- --------------- Date----- '7/- & - { , SAN JOAQUIN LOCAL HEALTH DISTRICT " w 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r ES 9 REVISED 5-59 3M 3-'S3 F.P.CD.