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FOR OFFICE USE: -� -- _ APPLICATION R=SANITATION PERMIT Permit No. ....................,...... a. f•'•1 (Cofnplete in Duplicate),. • jre - . Date . ................................ 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 Ordinance No. 549. JOB ADDRESS AND LOCATION...... ......6 / _ � � �'. f��...... ...�� / ----- ---------------------- ....-- �,(� •-- -0000-- 0000- ...............0000-...0000---0000-• Owner's Name. r/rt - �r t.. 4 /2�` ?'i:.C:J._::............... .....-...._ .......................- ...... .. Phona'r .................-1_`..Iq�7 Address. 1 �rZ... �� !�/ �Gl rZ'_... zi. ..7............................................................................................ C c c. Contractor's Name.. -n �... ............ . -Lf _ r .................... t-c Phone....---•-..................-------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑Mier Court ❑ Motel ❑ Other ❑ Number of tiv m;t—units: _� Number of bedrooms ... ._.. Number of baths .7'Lot size __._-ll�e_ --- ------ Water Supply: Public system ❑ Community system-El 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,date.-- _ .............I No 54_�lew Construction: Yes [t ,-No ❑ 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.-r-.n....Distance from foundation._._ ....material -�-� ._.. ......� -....... No. of cam artments...._._._. -7.--'.....Size._. >C..___'_...'(.._.__.Liquid de th.___._..l ... __z_._.Capacity. Disposal Field: Distance from nearest well__� `_Dista cn a fr`om'foundaiion... �-------Distance to nearest lobline..: ..�.... Number of lines............._ ' Length of each line......_L.Z?....._.. ..Width of trench..._.................... .....- „� al' _.. Type of fiiter material___- --I;...._Depth of filter material..... .....Total length.-.-... ...................... 6 Seepage Pit: Distance to nearest we':I....... Distance from foundation----- .....Distancg to nearest lot line.-..C:--- S Number of pits .../..........Lining material... d�f�/Size: Diameter. ....�:.{_.. S�- .........Depth-6 th.. _ S Cesspool: Distance from nearest well.................Distance from foundation__...,...............Lining material .......................:....... ._._ ❑ Size: Diameter....---------------------- ...... -.-Liquid Capacity. --_-_---------gals. Privy: . Distance from nearest well-.._J........_. Distance from nearest building.......................................... , ❑ Distance to nearest lot line-----6----------------------------------=-- ---------..................._--------------- ------•----•-•-------•------- - ---_------ Remodeling ---------Remodeling and/or. recairing (describe)--..... ........... • G ...................................................... ----- ..................-------............................--------._......... ----- ----- ••----....... -----............-............ ._._._......................... G -�`-=---------------- .................0.............--------•-----;--------....-----------._..._........ ..--------------------------•----....-------•---.._..0000.._................ ............0.. . -- -------6 •----------------------------...... ......�.......................---•-----•---•-• ----------------- ........... ...----.......... ............4........ 1 hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws 4nd les a regulations of the San Joaquin Local Health District. (Signed)_..j�.... ,/.:. �.�.. - jl /j/lli�� ---------- ---------------- ----------........ .......... --.._...............(Owner and/or Contractor) By:------------ ------- ---------------------------------------------- -- .6........... --------•--- ------------ ------(Title)-------------------.------------ _.. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... .. ~`J y ~y� = - -:..-----------••--•----. DATE....... - REVIEWEDBY-----------------------=---------------------- •---•-•-•------------ ......._......_......--••-•-•--•-. - DATE BUILDINGPERMIT ISSUED--•................._----••--------- /y r� DATE--•--------------..-----•-----.:-_--. •_--0.......... Alterations and/or recommendations:._-.... � .. -� 7..,.....- . /�"` '! ��"------, 1.--`=..��... - •---•••. ......... ...... ------------------- -�G v . .. ....... ................................• ............................................... ..........................--•0.00.6------------------ . ..................................... ..... .......................................... .. ..................................... ......................................... ..... ..... ...................------- FINAL INSPECTION BY:-.-.: ,. Date.. 0000-- --.- :- ' 1` N J�UIN L CAL HEALTH DISTRICT ` ti 1601 E.Hazelton Ave. 300 West Oak Street , X424 Sycomore Street 205 West 9th Street Stockton,California Lodi,California P `r r Manteca,California Tracy,California [S 9 REVISED 8-59 3M 3-'63 r.P.CO. l