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FQR QFFICE USE..-- --- ------- -- A Permit No. ._..�../_l - _ .. APPLICATION FOR SANITATION PERMIT -- (Complete in Duplicate) 3 Date'Issued'. - i-- - This Permit Expires 1 Year fFrom-Date Issued Application is hereby made to the San Joaquin Local Health District for s permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ! 'D1i l'7n S" -times. , 4 _ I JOB ADDRESS AND LOCATION:`F�r_r f e f�- 9Rd, n .r �D----- --------------- - Owner s Name +p. � ---— ----------•---•--- Phone Id - --- - -------------------------- I ----- ----- Address---------��--�-{-•-------------a•�- =�'�--------`-------�•----- ---- •----------------------- - • , , �'' �-+ ._-- Phone_/�rd�-Vf•Z----------- Contractor's !Z _- Contractor s Name---- - --------"rte ------ --- - ------- ------•--•----- ------ Installation will serve: Residence [E- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:;•__I__{Number of bedrooms -3---- Z3 -- Number of baths __/ Lot size -- --- Water Supply: Public system '❑ lCommunity system ❑ Private [fir Depth to Water Table eft. I Loam CIa Loam Cla ❑ Adobe�" Hard an ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy ❑ y ❑ Y 4 Previous Application Made: (if yes,date-----------:-------.} No [g' New Construction: Yes B'' No ❑ FHA/VA: Yes ❑ o El TYPE}OF INSTALLATION AND SPECIFICATIONS: - ]� [No septic tank or cesspool permitted if public sewer is evadable within 200 feet. Ma+erlal__ .- �` ------ � i� r � � Ec�f� GAO r-c Septic Tank: Distance from nearest wel#----S�'__ __.Distant from foundation_---j. _ ---- No. of compartments---------2-------------Size__&/ , -� Liquid depth----`.]C---------....------Capacity--- ,i i pis os f n p al Field: Distance from nearest weil__�Q'_______:Distance from,yfoundatio�___.�______________Distance to nearest lot`ine__.�__,..____. t [ ' Number of lines-_.-______._-------------------Length of each line_ ?-__ _f '�x _.Width of french._____*-__f..__- _-_-___�_____ N Type.of.filter.mat erial---8_a_C -------D-epth-of flter•„,material -__Total length_ --------------__________ Seepage Pit: Distance to nearest well___� _0__�_-_____ Dis#encs from foundation____f Distance to nearest lot line--.X --------Linin rnaferiel---/ oc_�C_--.Size: Diameter---- - _r--------Depth------T--�-.----i---------- �-. :! Number of pits_____.,_._ g Cesspool: W Distance from nearest well__________---- .Distance from foundation----------- material______________________________-_.-__. l - ----- 9als.Sie: Diameter--- ----------------- ------- -- �Depth------ ---------- ------ --------- - Li Liquid Capacity --------- ❑ = Privy:F .. Distance.from nearest well___..- 7--------------------------------Distance from nearest building --------------------------- ---------- �yt -ea es --------------- -------- ❑ Distance to�.Tnearest-lot liner -.r��;---- --------_�,�--_:----�--;:;,--,------- ------------ ------------------------------- --- ��,�' � � � � i Remodeling and/or repairing describe}----------------------- - -------------------------------------------------- -------------•-------------------•-•- - ------ ---------- ---------------- ------------- I-=----- - - --------------------------------------------------- --------- --------------------------------------------------- ---------- ---- ----- - ------- ------------------------------------------------- ---- ---------- ------------- --- --- --------- --------------------------- ---------------- ---------------------------------- !',hereby certify that I have prepared this application and thatthe work will be done in accordance with San Joaquin County ordinances, State I ws, d'rules and re ulations of th a Joaquin Local Health District. Si r - ---�i--- ---------- --Owner and/or Contracto gr d f By...: ----------------=--------------[Title]---------------- ------------=- ---- ... ------. - (Plot plan howing size of lot�,locatiot om f-syste -in-r'�ela+ion to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- = " _ ` =------------------------------------------------------ DATE --- ----6 ......................... -----. ------.------- -- REVIEWED;iBY------------------- `�------- ---------------- --=' ---------'------------------- --------------------------------- DATE--------------- ------------- --------------------------- BUILDING'',PERMIT ISSU,ED---------- ----------'-------= ---- =� = DATE. ----- - - Alterations and or re�ommenda�-tions. ---------- t.____�.�r//,��y ----------a ' y t t ------------------------------------------ - -------- Iff I -,r _________________________________________________ ________--------------------------------------------- ___.N_ _ ____________________________________________________________________ , tf ______________________________________________________________________________________________ .__._.______...__-_____b__________________________ - L INSPECTION BY.------- -- s----------------------------- {.: Date----,T T_ t--- a SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave- 300 West Oak Street 124 Sycamore Stresl) 205 West 9th Street y > _ �• . 'Stockton;California Lodi;Californias-,---"" "� """^ anreca,Califo�riia Tracy,Californid. CS 9 REVISED 9-59 3M 3•'63 F.P.CD.