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FOR OFFICE USE: Or 0 /Z.. Corps p -------------------------------- ---------------- APPLICATION FCS SANITATION PERMIT Permit No. �,.-1..71. ---------------------------------------------------- (Complete•in Duplicate) Date Issued ----..----------------.. ..... 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--------------------------------1--�--IA------------ ------Qt_,1.-e-v....CJu.b--------- ------- Owner's Name---------------- .............-tea-S'..-pq✓rI_ey.A---- -- . _ - Phone------------------------------------ Address.............................Va r u ................................................. .--��-------- .. cS -------�- '11�'-A------------------------------------------- Contractor's Name----- G - p' ----- ------ ---------------------------------- ------- ---------------------------------------------- Phone----------------------------------- Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ]� Number of living units: --I----- Number of bedrooms _j_.---- Number of baths---I... Lot size ---- _-_J.0-_II__________________________i Water Supply: Public system ❑ Community system ('� Private ❑ Depth to Water Table ft v` Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeU Hardpan ❑ Previous Application Made: (if yes,date------------------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ 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 foundation------- _!--------Mate�ia� _v_.C�Lr9-� ____�� _i b.PYC- J9 No. of compartments_.------------7.--------Size__'C).Y-.4p_Y-- '-----__Liquid depth------- 1.- ------- Capacity_i_ets`0 Disposal Field: Distance from nearest well-----.�'`------Distance from foundation----1CQ_---_----.Distance to nearest lot 1I e.._<5`___-_---� Number of lines________________ Length of each line____-_. ._._ d- nit----- --------- 9 �""---;'--------.Width of trench-------- of filter material._Rg(7�%4 --------- of filter material---_1_?------------Total length__-__.._F________________________01 Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line__-__.__-_.---_-- ❑ Number of pits-....................Lining material----------------------Size: Diameter__---_.__-_.---___-_-Depth_.----------------------._._-__-_ Cesspool: Distance from nearest well ________________Distance from foundation----------.-----. ..Lining material-_-_-------._.--.__-__.__._.-___-___-. S ❑ Size: Diameter- -- -------------- -------------_Depth--------- ---------------------------------------Liquid Capacity_-------------------------gals. Privy: Distance from nearest well-----------__------------------_--------.-----Distance from nearest building-_______________________________________. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------- ---------------- ----------------------------------------------- -------------------------------------------------------------------.----------------------------------------------------------------------------- -------- ---------------------------------------------------------- -----------------------------------------------I---------------------------------------------------------------------------------------------------- --------------------------- ----------------------------- 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, and rules and regulations of the San Joaquin Local Health District. (Signed)_____________ _____---------_______ __ - - (Owner and/or Contractor) ---------- -- - --- -------- -- -- - ---------------------------------------- E - ,-� - - BY:------. f------ -------=------------------------------(Title)---------- ------ -------- ------------ -- ---._.._------ (Plot plan, showing size of lot, location o(sys em in relation to wells, uildings, etc..can be placed on reverse side). ;. FOR DEPART NT USE ONLY APPLICATION ACCEPTED BY- - a =` - -------------------------------------- DATE- `----- ------------ --------- REVIEWEDBY----------------------- ------- ._------------------------------------------------------------------------------ DATE-------- --------------------------------------------------- BUILDING PERMIT ISSUED- ------------------------------------------------------------------------ -------------- DATE----------------------------------------------------------- • Alterations and/or recommendations-------------_-- -------- ------------- ---------- --------------------------------------------------------------------` --------------------------------- ------------------------------------ ----- ---------------- ------------------- -------------------------- ------------------------------ ------------- ----------------- -------------------------------- /------------------ -_----------------------- - ------------------------------------ ----------------------------- ------------------------------------ -- ------------------------------- ----------------- ----------- - ------------------ FINAL INSPECTION B - ---- --- = ------ ---- Date--------- �J .. -_--_------------------------ AN AQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelto ve. 300 West Oak Street 124 Sycamore street 20.5 West 9th Street Stockton,California Lodi California - Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press