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EORQ7 ICEE: �} 1� _ 0 APPLICATION f8i SANITATION PERMIT Permit No. ..... ._ ------ (Complete in Duplicate) Date Issued .__ �40-3 -----------------------------------------------------.--- . � 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 Ordin nce No. 549. JOB ADDRESS AN LOCATION!_.-Zj. 0_- -- -----------•---------------------------- r / ' ------•------------------------------•---------------------- Owner's Name --------------------- - Phone-- ------------•-•--------..-------- L , R Address-------------+$_�S _ Win- =fit - .. Contractor's Name ----`- 5---------------------------------------------------------------------•--- ---------------- Phone------------------------------------ Installation will serve: Residence [" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _J-___ Number of bedrooms __3_- Number of baths J_-_- Lot size Water Supply: Public system Community system ElPrivate E] Depth to Water Table 40 ft... Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ Adobe lla-"Pardpan ❑ 11%,__ Previous Application Made: (If yes,date---___________------l No ( New Construction: Yes 2?"'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 T k: Distance from nearest _---.--Distance from foundation-A-_f----------Mferia)__-� ____._ No. of compartments---__;;? i______________Size----�XLS -------Liquid deI?th- °I------------------Capacity---&-Q4 r-` jam\ Dispos Field: Distance from nearest well'-�.......Distance from foundation,�0-------------Distance to nearest ]of line._-_ .-__. Number oflines------3-------------------------Length of each line4 y'-_j�O__-`_4Z'Width of french--.-2, `'_--.-_---_-_. ____--- Type of filter material__ C4-----._--_-Depth of filter materialiff-y---------------Total length-----A16r '------------------------ Seepa Pit: Disfance to nearest well---_—_-----------Distancearom foundation-/#.F --__-.Distance t nearest lot line--d _--_-_-- Number of its-_-- --___--- '�I�' ' �� - J pits-_ _____Lining material.._ ._6fa,_�- Size: Diameter_3�_-�.1-C'�_Depth_�3_________________________ Cesspool: Distance from nearest well-------------- Distance from .foundation--------------------Lining material------------------------.__---._----- ❑ Size: Diameter 7---------------------------------------Depth-------------------------------- - -----------------Liquid Capacity--------=---------------- --gals. Privy: Distance from I nearest well________________________ ------ -------Distance from nearest building------- - Distance to nearest lot line------------------------------------- --------------------------------- Remodeling and/or repairing (describe)------------------------------------ -- -------•---- -----------•-------------------------- -----------------------•-- -------- -------------•-•---------------------------------------------------------•-------------------•--------------- ------------•--------------------------------------- t - , ---•---------------------------------------•--------••----- --• ----------•---------------- •------------------------------------ - I hereby certify that I have prepared t ' app(cation and that the work will be done in accordance with San Joaquin County = ordinances, State laws, and rules and regul ions f the n Joaquin'Local Health District. { -- (Signed)------------------------ -------- ---------------------------- ---------------------------- -------------- -----(Owner and/or Contractor) By:------------------------------------------------------- ------------------------------------------------=-------------------------(Title)------- ---------------------------------- ------------ - .... (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------=_-------------------- ------ DATE----- - REVIEWEDBY ----------------------- ---------------------------------------------------------- ------ DATE----------•---------------------------------•- BUILDING PERMIT ISSUED--------------= ----------------------------- ------------- ------------=--=------------------- DATE---------------------------------- -------------------------- Alterations and/or recommendations:-.--------------------------------------- -----•--------- __--- ---------- = ---------- sz �' ----------------------------------- ---------------------------------------------------------------------------•------------------------------------------ ---------------------------------------------------------- f FINAL INSPECTION BY•---.L-_---. --- --• --•- --• -- --- -------- --- --------- • Date--- �- - - ----------------------- SAN --------------- SAN J AQUIN OCAL HEALTH DISTRICT 1641 E.Ha:ellon Ave. t 300 West Oak Street 124 Sycamore Street 205 West 9th Street s, Stockton,California Lodi,California Manteca,California Tracy,California 9;5 9 RFVISEP 93-59 3M 3-'63 F.P.M3.