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FOK OFFICE USE: C1: .__ ^_------ APPLICATION FOR SANITATION PERMIT Permit No. - -1 --------------------------- -------------------- (Complete in Duplicate) ' -.--- This Permit Expires 1 Year From Date Issued - r Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and i stall the work herein described. This ap lication.is made in compliance wit County Ordinance No. 549. �o (P2L�C �.- �� u � .7 JOB ADDRESS AND O TION.---_-- --- '- -----G1� Nil1 - ,�9cF` ----- - . ,.$-. Owner's Name I1 ---------------------------------------------------- -----------------=------- Phone-;" 74-Za- i Address-.----------------------- -- ------ --- ---Q.. ----- --------------------------------------------------------------------- Contractor's -- ----- -------------------- Contractor's Name----:2)<-./ -',e�� -- -a��s `� ------ Phone---o- Vo / Installation will serve: Residence E�t`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -----/- Number of bedrooms -�K- Numb''*ffif baths Z_ Lot size - ti1d-_X- .--.-r----_._-- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table A_J_ Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E� Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-- 1 No Dd 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.) t Septic Tank: Distance from nearest well_15�p-�_Distance from foundation-_14P--.___Materia• CuCsr -+`P------ No. of compartments... ..----Size__-6.4f_3,,e4_-Liquid depth__ -.r-`7_-----Capacity.--, ..-_ � t Disposal Field: Distance from nearest well. `/>--..._.Distance from foundation-------------------Distance to nearest lot line-_---_------_---- f ® Number of fines--.-___- - Length of each line_ -' �-_�?.--Width of french--- Type of filter material �l1�----Depth offfilterrmaterial_40---------.Total length-----,led__e----------------- �.: Seepage Pit: Distance to'-nearest wolL�e --.-.--____Distance fr m foundation_-¢D---------- Distance to nearest lot ]in e--�_-__--_ Number of'pits------;:2..----------Linin material-5--� - ------Size: Diameter.3!�-'"--------€}eptly-.a.2•�-�___------------------ . � N Cesspool: Distance`from nearest well' :' "Distance"from'foundation--_----------------Lining material--.-----._..-_____-----.-----_____-_ ❑ Size'Diameter.------ Dept f p yt ----=---- L1iqu:id Capacity---------------------------gals. .�. ., , 4 I ,`. Privy: Distance from nearest welt----------------------------------------_-------Distance from nearest building.--.-.-..._____-_-.--._----____--------.-. ❑ Distance to nearest`lot line ------------------ ------ ---------- ---------------------------', ----- r RemodeT g',and/or repairing (describe): _- _--. __--: '- ' Z5__-_7_7s.� ,.. ------------------------ --------------------------------------------------- - ----------------------------------- ----------------------------•---------------•------------------------------------------ ----- -- ------_ -------------------------------------------------- ' :------------------------------------ S ' --------------------- ' ' ' to 1 hereby certify that I have p pa,�red this application and that +he will be done in acco dance with San Joaquin County ordinances, State laws, and rules 'an IatiAs .of theSen Joaquin cal Health District. (Signed)---- --------{(;rner d/or Contractor) By: ------- ---- - - --- ---- --------------= ---------------------------------------- (Ti4le}-. --- (Plo+ plan, showing; ize of JotIocao- syst fe in rela+ionto wells, buildings, etc., can be placed on reverse side). r. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY e --------- - ------------- --------------------- DATE--------------——� REVIEWED, BY------------------------------------ ------------------------------------------ ----------- ------------------------------•--- DATE------ ----------------------------------------•------------ BUILDING PERMIT ISSUED------------------------------- -' '.� . TE _._�. Alterations and/or recommendations:--------- — g/fz --. - --- --------------------------------------------------------------- -------------------- -------------•--------------- .......:•-------------.-- --------- ---------------------------- ---------------------- ----------•------------------- --- -------- ---------- 74 - ---------------------------------------------- - .-•- _----~------------ -------- ----\#----`------------`- -a ----------------• --------------------- ------------ -------------------- ....... ------------------------------- -------------------------- a------ - ------------------------------------------ --- ---------------------------------- - ---------------- FINAL INSPECTION BY: - Date------------- - ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ;! 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.c o.