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F R OFFICE USE: ------ ------------ /.�r ----��----- Lt ermit No. :. APPLICATION `AOR SANITATION PERMIT Pi / [Complete in Duplicate) Date"Issued .__1� •---b 3 ----- ------ --� ---- - ---- ------- - This Permit Expires 1 Year From Date Issued Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------- 3--------------`-�-T------ --=-- ----------------- � -% -r�� �� -- -- - --------••------------ T_ . --- Owner's Name -------- 7------_"� /- Ph 3s one_ - S IY2S r,� Address------------------------�--•----=-------••--------------------- -----•-----•------------------------•-----•---,---•-------•-•-------------,--•------------------------7....-----------------------••------.... Contractor's Name-----1------=------------------------------I '`-G1 � ------- -:«--_--- _---- --,-------T = Ph P,. . m...,.....ouse +�.�� ' Lot size ,� � Other ❑ Installation will serve:nl Residence Numberofbedrooms "",Number Commercial of baths railer Court Motel v/a Number of living # Water Supply: Public'system .Community system El Private [I Depth to Water Table _ ft. Character of soil to a depth of 3 feet: and [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ,Clay ❑ Adobe` ' Hardpan ❑ , ► - -� '-FHA/VA. Yes E] No. Previous Application Made: llt'yes,date............... 1 No ❑ New Construction: Yes `No ❑�. { \ TYPE OF INSTALLATION AND SPECIFICATIONS: - -.(No septic tank for cesspool permitted if public sewer is available within 200 feet.) I t _r- Septic Tank: Distance from nearest well_______________"-Distance from found on---�_._-_____--".Mater' t � ------Size------- x 4 Liquid depth--------- ---•---------- !Capacity-------- -0�7---- ` No.�of compartments______ _._ ______ - } 1 Di s osal Field- Distance from nearest wellll,-. - `___-Distance from foundation-----1_�?--------Distance to nearest-lot��-�.---- umber of lines----I'---'--#--� ;-----t-- ----Length ofear h line-------- Width of trench----------- - 11 ii t i' l �' • --rrl--- d V Type of filter material--!-., -Depth..o1!§'ilter material. ._..._Ik--_---Total length-`_"___-_,"---------- --- Seepage Pit: Distance to nearest wetly__ : Distant fr�idation__..__�d-____.Dist n�e to nearest lot line_________________ { Number,of its Linin d material- Diameter P 4 Cesspool: Distance from nea'rest'-wei r.---- ---Distance from foundation...._-_--___{._,_Luring material---------------------------__________. ' ❑ Size: Diameter.---------------------"--• - '---.Depth Liqu':d Capacity = gals. ,, i c._._... � i f Privy: Distance fromf nearest well_____.,__:- _- `"----- --- -Distance from Inearest building_L---------------___.__________.._._._. Distance to nearest:lot line----------------------------------- --'----- t 1 A Remodeling and/or repairing (describe):____-'*_"-----_-_-_-" �` ---- ----------------------�------I--------------------- -_...------------ --------------------- ----------------------•-------------�-- ------------------------------------------- ------------- S } } f d ;- ---- ------•----------------= I hereby certify that I have prepared this applica+ion.;and that the work will be donein accordance with San Joaquin County ordinances, State laws,} d r s and regula nsfof the�S Joaquin Local Health"District. ' (Signed)------ � � ---- �, ---------------- Z _ �----- --- ------------------------------------'�--=- ----------------�----------.............. - - ---------{Owner and/or Contractor) tTitle---------- By:----------------------- ------•---------- -,------------------------ - (Title) (Plot plan,.showing size of lot, location of,system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY . E - �DATE---------- - APPLICATION ACCEPTED BY L---------- ----------------------------- � REVIEWED BY------------- ) ------ -------- ---- ------------------------- TE---•-- ------ 1•---.------------------------------------ * BUILDING PERMIT ESS' ED--- - DATE.--------- -------- ---------- -- - =--------- / ------- Asa: 1 Alterations and/or recomm�esndations:__)_'-._Z_�_' -,.�P� � ��----�--`- �01 �� ��. -------- i.F, -- _ - --------.--------- ---------------------------------------------------------------------------------------------- -----------I------ �� -�------ -i: � ' -z� ` --------- FINAL INSPECTION BY:. �1_•� '' w Date.------ _ L --�-- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Are. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Cry 9 REVISED B-59 3M 3-'63 F.P.C13.