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FOROFFICE USE; - ' ` - -`f------------' —� --?/-_I_7__________________-_.__..__-)_jAPPLICATION FOR SANITATION PERMIT Permit Na. - ------ {Complete in Duplicate). --- ---------------- ------------- ' This Permit Expires 1 Year From Date issued Date issued i Application is hereby made to the Sen 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. S49. �'7 A JOB ADDRESS AND LOCATION--:----. 0"--Z-i---R--- -}_Y _1Q_2i,,� S .I__c--•------------- Owner's Name---.r=-r_ - _RA-I_ r ------------- Phone-_L.(t_?—�7 - Address----------------- F Contractor's Name----- Installation will serve: Residence P Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living,units: �___ Number of bedrooms __'L-- Number of baths ___l____ Lot size ___ Sp-_`_ ----J..pD-.'_____________________ Water Supply: Public' .. Community system ❑ Private ❑ Depth to Water Table _,6p 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------ ,_.._-_._) No New Construction: Yes ❑ No [X FHA/VA: Yes ❑ No)6 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-_Distance from foundation___________________Material.-______.-.______.____-._____-_____._.________. No. of compartmentsl-- -------------------Size-----•-=-------•--------•---A Liquid depth--------- Capacity Disal Fiel Distance from nearest well- est_Distance•from foundation-__1_p_'-------._.Distance to nearest lot line.__!__.__ • Number of lines__s________[ ________________: Length of each line -----------.Width of trench.----------- � Type of.filter material_ _,_ .�L__Depth of.filter.;material-_-..__1_FS"____-_Total length___---------------- _— ---- F Seepage Pit: n Distance to nearest well_-"l s ---Distance from foundation______cP........Distance to nearest lot line------2.�-� Number of pits------.--(-------s.----Lining materiaC_ S.2s��,lC_-Size; Diameter_-------,,3.3- -----Depth--------2-f"' --------------- J Cesspool: Distance from nearest well-___`._____._Distance from foundation-________________ .Linin material__-__.-_____-_____-_____-._ .� _.�, 9 ----- ❑ Sze: Diameter. - ----Depth------------------------ -- ---------------------Liquid Capacity-------- gals. N 1 11 - Privy: r: Distance.from.nearest well._=___________---------------------------------Distance from nearest building.____.- ❑ Distance to nearest lot line________________' Remodeling and/or repairing (describe}:-----/��s(------_-�-------�7c-r_�� ,,��---------_— i ----------------------- ' ___________________________________________ ` . . _-. _•- _____n- - - .-_- ! hereby'ct�rtify that I have prepared "this application and that the work will be done'in accordance with San J_oaq- uin C-oun- . ty. I ordinances, State laws, and rules and regulations of the`.San Joaquin Local Health District. (Signed----------- ------- ----------------------f ( Contractor) BY:---------- ---I (Title) caner and/or z-'�- __ _ -- ( -- - ------------ (Plot plan, showing size of lot, location,of system in relation to wells, buildings, eic.,;can be.placed on reverse side]. c fi t � . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ------------- tl5----------- ---------------------- ------------- DATE REVIEWED BYI--------------- 7Ln- 6y ------------------------------ ------- DATE--------- --- BUILDING PERMIT ISSUED--: -;r- i DA• ------------------------------------------ erations and/or recommendations:-,=0,� °.. ca--- - ___ L� , " -- :---------- ------------------------------------------ •------•---------------- ____________________________________________ _________ __._ ___---- A i Y , ___________________________ _______________ I, . , ! __________-___..__.______-.-____._______._._________-__.______._______-____.____ i r - - --------------------------------------------------------- ------------------- - ---- -- - FINAL INSPECTION BY:---- ----------- - ------ :•- . Date----- / .- sN _�, - , , I - ------ --------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED B-59 3M 3-'63 F.P.gp,