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1-UK UfrlC,t UJt: ------- LICATION FOR 'SANITATION PER" Permit No. ........................ --------="-------------------------------------- {Complete in Duplicate ------ This Permit Expires i Year From Date Issued Date issued , 1= � plication is hereby made to the.San Joaquin Local Health District for a permit to construct and install the work herein described. I 9pplication is made in compliance with County Ordinance No. 549. A-c 'DRESS AND LOCATION........ _ ]_'�Ib----- f�QZG ...a ..--------------------- - --- me-------•--------------------LUC_a'-.....f3-U_rm ----------••-------------- ------ Phone-------=�-------- --------------------------------- --------- k - ---------------�_ "actor's Name-------------------------UX-ruep-------------------------------------------------------------------------------------------------- Phone.....""`_"_ -------------- Installation will serve: Residence EKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: al--- Number of bedrooms Number of baths Lot size __-_._--_3 __.:--------------------------------_-___ Water Supply: Public system ❑ Community system ❑ Private Ej'�pepth to Water Table __?_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0"'Hardpan ❑ Previous Application Made: (If yes,date-----------,--------) No ffr New Construction: Yes ❑ No [3-_FHA/VA; Yes ❑ ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----- -----Distance from foundation----f0----------Material------C-AAkrCt2> „_---_-___--_------. Er No. of compartments---------Q------4.----Size_..__' /d -__Liquid depth__-- /`z,-------------Capacity----7 _ Disposal Field: Distance from nearest well-Aq-------- Distance from foundation----. D--------Distance to nearest lot lid---_r� [ Number of lines----------- Length of each line__-___--_-�0-----------Width of french_-------V------------.----_-__ Type of filter material__ __� ___-_Depth of filter -/-- _ - Iter material_-_-- -- ______-Total length --------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation__....._............Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter---------------------- Depth--------------------------------- Cesspool: Distance ff-om nearest well-----------------Distance from foundation--------------------Lining material-_-___----____-__--._---._._-_____--. [❑ Size. Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ 0- 11 Distance to nearest lot line-- ---------------------------------------------------------------------------------•------------------------------------------------------- Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------------------------- ----------------------------- ......... -------------------------------------------------------------------------------- ---------------------------------------------------------------------•--------------------------------------------------------------------- ---------------------------------------------------••-•-•---------------- ---------------------- ----•-------...-------•----•----------------------•------------------••-•----•-------•--------------------------- I hereby certify that I have prepared this epplicaflon and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San oaquin Local Health District. {Signed} ------------- ------------•----------- (Owner and/or Contractor) EY: � - 5 � -------------------------------ITitle)--------------------------------------------..... {Plot pEan, showing st o lot, location dtsysfe in relation to. e , buildings, etc., can be placed on reverse side}. FOR DEP PENT USE ONLY APPLICATION ACCEPTED __ _ DATE---___ _� '��Y6� ----------•--- -----------------•----------•- REVIEWER gY---- •-------- ------•-- -- --••---------- - --- -- ----------- - ---- DATE_-------------------- - - ----•------------------- BLiILDINGPERMIT ISS ED ----------------------------- ----------------------- ------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:----------------- ---------------------------•-----•------------------------ --------------------------------------------------------- ---------------------------------•---------------•---------------=------------------------------------------------------•------------------------------- ----------------------------------------------•-------------------------- -----------------------------------------------------------------------------------...----- ---------------------------------------------------- r FINAL INSPECTION Date 94 ISAN JOAQUNLOCAL HEALTH DISTRICT ----------------------------------------------- 1601 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California gs 9 REVISED 9-59 3M 3-163 F.P.CD.