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------------� --------------------------- /_a__ PLICATION FOR SANITATION PE 'IT Permit No. ..L.- '..Z..�- it C! -------------------------------------------------- (Complete in Duplicate) 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. This application is made in compliance with County Orclinan e No. 549. JOB ADDRESS AND LOCATION.____._/-'_171 -.__.___-_.. .__.-._._-_ .__ /) ------------------------------------------------------ -------------------------- Owner's Name_..6z,--------- - �• _ --------------------------------- ----- ------------------------------- ------- Phone------------------------------------ Address----------------------_ 4 _ -- -------- Contractor's Name --- -_ L.! L_ ..---••-------------•--•-----•---••--------------------- Phone.-----------•-••----- Installation will serve: Residence [A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other V Number of living units: .__.. Number of bedrooms .c.. Number of baths -------- Lot size __ _ -yt^ ? --- Water Supply: Public system jg Community system ❑ Private ❑ Depth to Water Table .ys ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ Nox FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-.7.S------ Distance from foundation._J__O---------Material___ --- -.._.__._...__..-.. A No. of compartments_.__ Size. `� 9 P � - - Capacity--- -�--��---�. off--- ----- - - -�-�-�--�`- - --- ----Liquid de th --- -- r Disposal Field: Distance from nearest well__7�5-----Distance from foundation. _ .,0_____�_.Distance to nearest lot line----5... Number of lines___._._.______ _ __Length of each line_Z_�'.----`7D____Width of trench-------�._�� -.___..._.--.._ Type of filter material__t.. D Depth of filter material-_._`_0-`___...Total length_____________________ / Seepage Pit: Distance to nearest well_�.A_____..__--Distanc "- M undation____�.Q__-.__..Distance�? nearest lot line..... ....Number of pits----v2-------------Lining materiaa -----Size: Diameter-�$_--�4-----Depth------.-- -.1- --_.-. Cesspool: Distance from nearest well---------.-------Distance from foundation--- --------------_Lining material.__....___._..____.______..__..... ❑ Size: Diameter--------------- --------------------Depth------ ----------------------------------------_Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------_Distance from nearest building----------------------------------------- ElDistance to nearest lot line--Q----•- ------------------- -----------------------------•-- ------------------------------------------------------------------- Remodeling and/or repairing (describe):-------v- --- __ ----- _ ---- -------------- ---_ `_ ------------------ f A ,x±l g =----- � ---------------------------------------- ---IV�_ certify that I h e prepared this application and that the work will be done in accordance with San Joaquin County I herel�y or inances a laws, anles and regulations of the San Joaquin Local Health District. (Signed)---_-- -- --G��,/ •- -� -- `-_----- .---.---.-- - - Owner and/or Contractor) By:-------------------------- F ---- ---------------- -------(Title)--- - - - _ (Plot plan, showing size of to+, location of system in r a 1 o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / - •--�� ------------ DATE--------- ----APPLICATION ACCEPTED BY---- ��--�r---------- ---------------------•-----•-•----------..------•----- - . �................ REVIEWEDBY---------------------------------------- ------------------------------------------------------------------------------------- DATE---------------------------------------------------- BUILDING PERMIT ISSUED - -- DATE r� ---------------- .--- 1 Alterations and/or recommen ations:----------ZL'----=�__..=__-_. ._. �------ -_..: a„Z.G -- x ' .T�.. ` 1 '�: 1`7_h -- ` `f------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- ------------- - --------/-----`---.... --------------------- --------------------------------------------- -- ------•----------------------------------/----------------------------------- FINAL INSPECTION BY:----`-_-`I--_-_.._._ z.. —_-...._ Datef` / L j -- ------------------------'---------------------------------------•----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca,California Tracy, California cc 4 RFVI D 9-59 n. 3-'6'3 F.P-Cn