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USE: 3� f -6-VROFFICE ------------------------®------ FBF APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 1 Date Issued .... Yf . �a/ ----------------- This Permit Expires 1 Year From Date Issued ._. _.......y . 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 Ordin nce No. 549. 6 JOB ADDRESS AND LOCATION_.-?-?..33---•-----• - - ---- - ----------- ----- -------- - -----------------------------=----------•--------------•-••---------------•--------- j Owner's Name------ --- r1r Phone Addressc 5!�71 . ------. C -------------------------------------------------------••----•----••---- Contractor's Name----- V Phone.. --------. Installation will serve: Residence Zi-- :Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ J Number of living units:'---I---- Number of bedrooms,.3. Number of baths�. Lot size __-_..fit S ......�.7 �-g....--._.-. Water Supply: Public system Community"system,-❑--Private ❑ °Depth to Water Table,.. ft. Character of soil to a depth of 3 feet:",' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa-m.❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date... No New Construction: Yes No ❑ FHA/VA: Yes p 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.�-------Distance from I foundation. fl____...._...Mate�ial. 1..--_. - ------------------------------- No. .- -. No. of corn partments...._- - Size � Liquid depth---S ---- - -- Capacity_ Disposal Field: Distance from nearest well--------- ---=Distance from foundation.... -------------Dis a ce to nearest lot line__...........- W. Number of lines----:_- -' -------Length of each line -`7 s5- ---r--------Width of trench.-,2.-Y-`'------------------- R Type of filter mafe-6 �►.4. -----Depth of filter material.�a-.....-- ._...Total Iength/��......................./.-..: Seepage Pit: Distance to nearestwell--.- ...._.Distancom foundetion... .....___Distance to nearest lot line.-_._-_._ Number of pits_____ __________Lining material...f-I,-V__C._AC'_.Size: Diameter---- .. p Cesspool: Distance from nearest well.................Distance from foundation-...---------------Lining material-------------------------------------- Size: Diame#er--------•--------.- --- r❑ P ----------------Deth---•----------'-------•------------------------- - -Liquid Capacity---------------------------gals. �i Pi?ivy: Distance_from,nearest`well-.. ___ _ _ _ _ _ _ _____________ Distance tram nearest building...--- ____.__ _ ._._....__i_ .._ .. 4 ❑ Distance to nearest lot line.....--_... ----------------------------------------------- Remodeling and/or repairing (describe)------------------_-.-_--_... i t F. _ - 7 ...........................L.................................:............................................................................................................................................................'._.. ! - n S - I hereby certify that I have prepared;t ' ppli tion and at the work will be done in accordance with San Joaquin County ordinances, S+a+e laws, and rules and regu ns the Srran aquin Local Health District. : r S � t -------- (Signed) Owner and/or Contractor :-----------------------------------------:------ ( / ) r . By:-------` - " --------------------------------(r+Ie} -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc., can be placed on reverse side). F 4.t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ......------'/0--�S-----------------------------------N------- DATE---------1} -:s------------ --- REVIEWEDBY ------------------•--=--------------- ---------------------------------- ------------------------------------------- DATE------- ------ ------------------ BUILDING • ---.... BUILDING PERMIT ISSUED------ -------•-- -----..------------------------------------•— --------------• ------:------------. DATE- -------------------{--------- ------- -- Alterations and/or recommendations:------------------ --------------------------------------------------------------•-------- --•---------------••----------------•-----•---------------------- I1 --------f-------------- --------------------------------- - =----- ------------------ ----------------------------------------- --------------------------------:---------------=--------------------------------------------------------------------- -------- --------------- -= -------------------------------------- ------------------------- - - ------- -- -- - ��ff FiNAt INSPECTION BY:. - ---------------- ------------- ; ., Date �. /_�. ../ i 4 S i SAN JOAQUIN LOCAL..HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak street `124 Sycamore Street 205 West 9th Street Slocklon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CC.