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F OF ICE USE: Jz-- ---------------cx Permit No.�I.7 4 ..� APPLICATION FOR SANITATION PERMIT [Complete in Duplicate]- _ 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 andi al the work herein described. This application is made in compliance-with County Ordinance No. 549. 07 ( /F - (0 3 - 23ro-r JOB ADDRESS AND LOCATION_} (� --- F '�/ Y r Owner's Name-_- ame_ � 1Y1- �jE `_ :.►-------------------------- = Phone ------------ Address--------•--------- .��.ZQ3�.1.C------ -----•-•---------------------------------------------------•------------------------------=----------- Contractor's Name...... "`- �----�- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . Number of living units: _____7__ Number of bedrooms 3--_ Number of baths : _- Lot size ----------------------- Water Supply: Public:system ❑ Community system ❑ Private 09--15'epth to Water Table __&t?ft. Character of soil to a depth of 3 feet': Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpon ❑ .� Previous Application Made: (If yes,date_..:--__..._..----- No New Construction: Yes RT_No ❑ FHA/VA: Yes E `Ro 0 t TYPE .OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool per if public sewer is available within 200 feet. Septic Tank: Distance from nearest well_�(1_?'__Distance from foundation_ _a_]___.._._.Mater�al_ -r - CV_ No. of compartments------Z----------------Size_�`4-- ---5__' �iquid depth--- -- ---------------Capaci#y Disposal ie4d: Distance from nearest we11%Z. _.U_..._.Distance from foundation_J-0__-------..Distance to nearest lot line______ _____ , Lk' Number of lines.-1A ---------------- - Length of each line_-76y. ------------------ ---------------.Width of french---4--�-- ------- ------ L� Type.of filter materia _____Depth of filter material --------------Total length-- =--•------------ -•-- Seepage Pit: Distance to nearest well__�_D.D-t______Distanceef�from foundation-_!_Q_�____--.Distance to nearest lot line _ --4 ---_____ � ' Number of pits--�--------------Lining material'__13iD-�-A-----Size: bisameter---- 3__..------_Dept h---.�5- -------------------- Cesspool: Distance from nearest well-----------------Distance from foundation....--_- -.---.Lining material------------------------------------- .____-Depth_________________' -------Liquid Capacity ❑ Size: Diameter- --�-------------------- - ------------- --------- • -------------- • ---____gals. O I Distance from nearest._buildin Privy- Distance from nearest well--=--------- -------------------------------- 9 ❑ Distance to nearest lot line---------- ---------------------------------------------------------------------------- ------ ----------------------------------'--------- ♦ - Remodeling and/or repairing (describe):-------------- ---------------------------------------••------------ u t ------------------------------------ - ' 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; 4nules and regulations of the San Joaquin Local Health District, r [Signed} LN 7Z ------- ---- '-(Owner and/or Contractor) - ------ } l 1 gy� Y `------- - - .-- ----------------------------------------------------[Title]------------------------- ._...------- (Plot plan, showing size of lot, location 'of syste .in relation to wells, buildings, etc., can be placed on reverse side). . t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- C-:_.. --�.c.a-------- ------- -----=----------------------------------------- DATE--------7--"z-,3-'--E' -------- ,.. REVIEWED BY---------------------I------------------------- -------------- ------- ---------------------------- - ------ DATE----------------------------------------------- •------------ BUILDINGPERMIT ISSUED--------- ------------------ -------------------------------------------------------------------- DATE--------------------------------- -------------=---- ------- Alterations and/or recom endations:____.--..-.-__.___.__-_.--:...___ - ------------------------ €/� ------- ------------------------ -------------------- ---------------------------- --- ------ FINAL INSPECTION BY:---------- J---------------- ------ Date------------ ---'34--�� r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Callfornia Lodi,California Manteca,California Tracy,California E5 9 REVISED 9-59 3M 3-'63 F.P.017. i