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rUKUrrlC-t uJt: --------------------------- -3-°--- J AF CATION FOR SANITATION PER Permit No. _.__Z-:"�........ ----- (Complete in Duplicate) i�_.. ---------------------------------------------- This Permit Ex ices 1 Year From Date Issued Date Issued ___ � f Application is hereby made to the San Joaquin Local Health District for a permit to construe d ' the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------- 3Z9 ids..--�---�-/'�� -��,�- .-.�,.DQ.------- --- ...... �- --------•...................... Owner's Name------------J-,!+%rrl -------- ••-•--•- ----•--------------- ---------"---•--- Phone 71,E Address F /�f7l�_.L� .. :------•-•. ...................... ��..' �----._ --- ---------- Contractor's Name........ 1� �--... � ----------------------------------------------------------- Phone_ .... Installation will serve: Residence ❑ Apartment House ❑ - Commercial B Trailer Court ❑ Motel ❑ Other ❑ Number of living units_........ Number of bedrooms -------- Number of baths -------- Lot size ----------------------------------*........_...-______.____-. Watef Supply: Public"system 5d Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: If yes,dote__________ ______){I No New Construction: Yes ❑ No 10 FHA/VA: Yes ❑ No,5l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6lic sewer is available within 200 feet.) i Septic Tank: Distance from nearest well______________ Distance from foundation_____________:_____Material!-..._..-_-_-_.____ ------------------------- ❑ No. of compartments--------------------- -1 Size----------------------------=---Liquid depth--------------------------Capacity-------------- ------ Disposal Field: Distance from nearest well______________.Distance from foundation_______.__..........Distance to nearest lot line__.____..._._.._. ❑ Number of lines--------------------------------` -Length of each line------------------------------Width of trench-------------:--.•--•--..-..__.---. Type of filter material---------------------- __Depth of filter material-----------------------Total length_______________.._...___._:.___________-__ — Seepage Pit: Distance to nearest ell__________________°'__Distance fr foundation---------------- to nearest lot line._____:_-._--__-- i )' __Linin material__ ��/ 5ize: Diameter__��.`____--Depth____ ��' -'______________ G Dumber of pits.----./---.--_-__-- g• G Cesspool: Distance from nearest well------------__°-_-Distance from foundation. __._.______-..--.__Lining material______._______.____._..______________ ❑ Size: Diameter. --------------- --------------- Depth----------------------------------------------------Liquid Capacity-----------------------------yals. Privy: Distance from ndarest well-___________________-___.____:___..F______----_Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line -------i-----------------------------------•-------------------------------------------------------------------------------------------- G ` i p Remodelinand or re p airin descriL�e :___ . .�1'!/r-%/ .._(_1X/,zf� C '_-_____I__ _ ....._.l l 9 / 9, -------------------------------------------- ------------------------------------------------ .:.....------------------------------------------------------------------- -----------"--------------------------------------------------------------------------------------------------------------•-•---.....-------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State-law and rules and regulations of the San Joaquin Local Health District. / 5 t-- , (Signed) 1 - 1---- /Jl` L j(o, er and/or Contractor) BY: -.. ---'------------------------------------------------------(Title)---- /-------------------- ---------------- (Plot plan, sho g size of of, locafon of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -- ------ --- - =--------------- DATE_ �G L REVIEWEDBY-------------------------------- - -- ------------ - --------- ' ....................----•--••--- DATE-------• --------- BUILDINGPERMIT ISSUED---------------------------------------------- ----- =------------------------- ------ DATE-- ----- •--•- Alterations and/or recommendations:----.1./�- - __.__.-.:. .G,_._. -- art - �.-c---�-•- -- ------ l 7� FINAL INSPECTION BY:---- L Date. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California; Manteca,California Tracy,California ES 9 REV1SE6 e•59 3M 3-'63 F.P.EO. i