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FOR OFFICE USE: Permit N ------- APPLICATION' FOR, SANITATION PERMIT o- ----- ------ ---------------------------- ----------- --- (Complete in Duplicate) Date Issued _____�_/_ /#cc y ------------------------------ -------------------------- 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-----5Zj !0**&A177! ------- -------- ---------------------------- Owner's Name---------kz/_j�?-----------------------<7 ------------------------- ----- ---------------------------------------------------- Phonw4-�7- �7- -Address......----- 4/1 . ------ ......:-�_ ------ ...........--------------------------------- --------------- Contractor's Name_ ------------------- --------------------------------------------------------------------------------------------------- ------------ Phone----------------------------------- Installation will serve: Residence tg--"6partmenf House [:] Commercial F] Trailer Court E] Motel 0 Other E] /V Lot size ------OW-6-7-L-�-- - -------------- ----------- Number of living units: /--_.- Number of bedrooms�K--- Number of baths '/�' e Water Supply: Public system 0 Community system E] Private E5Depth to Water Table*dlft. Character of soil to a depth of 3 feet: _] Sa'd F Sand Gravel E] Sandy Loam El Clay Loam Vj_-Cfay 0 Adobe 0 Hardpan E] Previous Application Made: (If yes,date.--_.____-,_..__...) No ffa--New Construction: Yes E-<o 0 FHA/VA: Yes D No El 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--J-0----Disfance from foundation__._/_C-�-------Material_!� '�_-,,,� -2* ------------ -..-y- No. of compartme CaPdciTy=/.. nts-------- -------------- depth------ ------------ ---- Disposal Field: Distance from nearest w9jJ.7_t_ /-Distance from fcyndafion__/;_0,____ _-_.Di Lance to nearest lot line---n Number of lines----__---;9L"___2-------Length of ea91Tine70V_ -----�idth of trench_-__�--- -rt---e�� materiel_.__] �7 7 Type of filfer.material-- - ---Depth of filter e------------Total lengfh---------1:1_4�---------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter.----------------------Depth--------- ------- ------- __:Z:: Cesspool: Distance from nearest well_----_--- --.-Distance from foundation--- -- --- ---------Lining Size: material----------------- ------------------ 11 - Mameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-------------------- -_-gals Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------_.---------_-_---__---_--.-- --------r ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------- --------- Remodeling and/or re-pair;ng --------- --------- . ...... ---------ir__7e__1---------3- ---------------- ----------------------------------------------------------------------------------------------------------I------------------------------------------------------------------------------------------------------------------ ---------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- I -------------------------------I hereby ce y that I h" ppare i application and that the work will be done in accordance with San Joaquin County ordinances, Stat lawi, and rule P' I ions of the San Joaquin Local Health District. (Signed)- --- --- ..... . ------ ----------------------------------------.(Owner and/or Contractor) By:-----L------------ ----------_ffitle)---------- ----------------------- ----------- -- -------------- -------------------------------------------------------------------------------------------------- (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-.---,/L/------------------ - ------------------ ------------------- DATE------1 4_Y;-- ---------------- -------------------------- ------ - ---------- ----------------------------------- REVIEWED BY----------------------------------------------------- ---- --- - - DATE - BUILDINGPERMIT ISSUED---------------------------------------------------------------------- -------------------i------ DATE--- --•-------- ----------------------------------------- Alterations and/or.recommendations:---------- �.1/.-. F- �/_ �_, ------------------------- --------- ---------- -------------------------------------------------- ---- -----1- ----------- ------- - ------ - - ------ -------------- --------- ------ ------------------------ ---- ----------- ------- -- ---------- ------ ---------- --1-7-—- --------�(------------ ---------- -------------------------------- qn,_,�-------- ---------- 1moi _e- -------- ----- ----------- ----- ----- . ....... f2z C,4—1 -I FINAL INSPECTION BY:_ ---------- _r Date. - - SA JOAQUIN ----------------------- LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave, 300 est Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California L!s 9 REViSED 8-59 3M 3-'r.3 F.F.C13.