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-. -r-iT wt,t• .....x..lye�... z,+ .1�4 .. .:i.",r« .. h �A , • APPLICATION FOR SANITATION PERMIT Permit No. ......_ S 3 (Complete in Duplicate) ID J Date Issued This Permit Ex fres 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 LOCATIO,N------t---------- �_k------fir-1'W.r----•----------------- tJ ---------------------------------------------------- A T Owner's Name-----------'-••---- I••K �-v`-"--------KA-r-i'm........ .....•------- ---- ----- Phone--1._ Address------------------ r�' r` ------ `----------- -----------------------------------------•------ i Contractor's Name----------------------- --- - -- ------ ---------- ----------------- Phone-----_� 4;;�..-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ TraiJe Court [:1 "Motel [I Other ❑ Number of living'units: __1___ Number of bedrooms - Number of baths �_f�ot size -----)___ _57.X---X-1_0-------------- Water Supply: Public system ❑ Community system ❑ Private &0`5epth to Water Table./I? ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No Zsr New Construction: Yes & No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) O p - p staiic `f.rom.-founds ion:'=_ _ �' Y # T- M'aterialI No. of compartments -- _r Size_______________ Liquid depth-------- CapacitY____ _ - I. i Se t'ic` an�:� Distance�' rom nearest-we __ Dir �r � ' � , � �-.: � _Te Dispos Field: Distance from nearest IL_ �.____Dis n e fro f u atio _ rte �Q. Distance to nearest ! G,e--- --_._.__. Number of lines---------- j ------------ ---Length of each line-------��------- ---Width of french....... ------------------__-- .-- Type of filter mate rial-__.1�-t__J_?6__'-/e%0,Depth of filter material___ ------Total length__---_- Seepage Pit: Distance to nearest well____________________;Distance from foundation____-_._-__---.-_-.Distance to nearest lot line---------------- ❑ Number of pits----------------------Lining material--------------.--------Size: Diameter------------------,----Depth_ __._-._.____________------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining -�- - - T� . rr , material-------------------------------------- _54e:. --------------------------_----- -----. _Sze:.Diameter_= - -----Depth- --------------- --- --_ _-' -Liquid Capacity - gels.--_- . Privy: Distance from nearest well --------------------------------Distance from nearest building------------------------------_-_-_--_-. ❑ Distance to nearest lot line---------------------------------------------- -----------•--•-------•-------------------------- ---------------------------------------- Remodelingand/or repairingjdescri13e):-- ------ - ----------------------- ------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- 4--- - - -- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules.and regulations of the San Joaquin Local Health District. (Signed) - .r -- . "---- J -----------------------------------------------------(Owner and/or Contractor) t _._Title ,(Plof_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 - _ _�_ _�._ DATE :- _2 -------- - - REVIEWED BY.- - ------------ -- ------------ ---------------- DATE BUILDING PERMIT ISSUED---------------------------------------------------------------_------------------------------------.- DATE------------------------------------------------------------- Alterations and/or recommendations:- -- --- -------;a, - --------------------•-•-----------------•-------------------------- -------------------------------------------------------- - - -- - - ----------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- ------- ----------- ------- ---------•--------,-------------------------------------------.---------.._.-------------------------...--------- ---------------------------------- ------------------ ------------------ ---------------------------------- ------------------------------'------ -----le-- -- -- --------- ---------------------------------------------------------------------------------------------------------------- V Date----------------------- -- FINAL INSPECTION BY: ------------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California FS-9-2M Revised 8.'59 F.P.Co.