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s FOR OFFICE USE: t9-----------------------�' _________________________________________________________ APPLICATION AOR SANITATION PERMIT Permit --- —----- ._ . (Complefe.;in Duplicate) - This Permit Expires 1 Year From Date Issued 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 wifh,County Ordinance No. 549. i JOB ADDRESS AN LOCATION /./0'.3 S 3 C --------------- --- , ------------- Owner's Na --------------------------------------- ---------------t ---------- Phone_ `/ Address- ------ --------------------------------------------------- Contractor's Name - --------- --------------•----------------------------------------- --=----------------------------------•-------- Phone------------------------------------ Installation will serve: 4Residence)K) Apartment House ❑- Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _,1--.- 'Number of bedrooms -- Number of baths -_.l-- Lot size -__-ZD X.Z:�1-7 1t Water Supply: Publicisystem [-] Community system El' Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ .Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [q Hardpan ❑ Previous Application Mader (If yes,-date__:.____---.__..___) No El New Construction: Yes E] No E] FHA/VA: Yes E] No E]e a �-c.o a� ... TYPE OF INSTALLATION AND SPEVIFICATIONS: (No septic tank"or cesspool permitted if public sewer is available within 200 feet.) 4 4 li I Septic Tank: Distance from nearest well_-__-Q---_Distance from foundation----/ ---------Materiai---1?e0,2 a0aw------------- No of compartments--------�_---_____-_ ___Liquid depth___-__4,r-.-------------"Capacity..._F-0-0..... t Disposal Field: Distance from nearest well__-s.1...0"Distance from foundation--/Q--_-:_---.Distance to nearest lot Number of lines---J---,,I. .-.---__---,__-__:Length of each fine-- d -V7d_...___-.Width of trench._, -. _ •-- 9 r�--------- -�-"-.---------- ---- - r, a Type_Of-filter material _. _ _ _. ------Depth of„filter,material.... ...............Total_length._�$�-_-lb -_---__-_-.---_ Seepage Pit: Distance to nearest well----/.Q0-----..Distance from foundation---- c. ____.Distance to nearest lot line----------------- Number of pits._..,!�_____________Lining mate .Size: Diameter_ -------.Depth-._ P,�-------;3_3__..._____ W Cesspool: Distance from nearest well-----------------Distance from fou ndation--------------------Lining material-------------------.------------------- Siz'e': Diameter------ ---- ----.---------------De th---------.---------_:__ _<- __ . _ -Li Liquid Capacity❑ a p Y gals. 04 Privy: Distance from nearest well------------- ---------- ------------ ------------Distance from nearest building_____________________ •----------------- ❑ Distance to nearest lot line------------------------------- ; ' Remodeling and/or repairing (describe) - . =! j ---•---------r �. --- ------ ----------------------------- ----------------------------------- ---------------------------------=----=--------------------------••--------------------------------------------------------•---------- --------------------------------------------------------------------------------------- 7,1',: p ----------------------- ------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and 'r9gul .tions of the San,-Joaquin Local Health District. r (Signed)-- ------- -------- -- - - - -- --•-----=----- ---------------- --------- - -- ---------------:------------------------------•----------------...(Owner and/or Contractor) B t (Title)-. }` . (Plot plan, showing size of lot, location of system in relation to'.wells, buildings, etc.,.can be.placed on reverse side). Al t € )- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- • = -------- ---------------•------------------------------------ DATE-----6-1;c-4q-1652Z4 REVIEWED BY-------------------------------------- - r, DATE ------ --------- -- -------., ----------- ---------------------------------- - ------------------------------------------------ - BUILDING PERMIT ISSUED-----------------1i - r DATE = - ------------- ----------------------------------------- Alterations and/or reeommendations:_._ Qr►c�...-. lF- - �c� ----&--`991 - -------------------------------•--------------------•------•----- --- ---------------------------------------------------------------------------------------•---•---•---•-----------•------ ---------•--- •-------------- ----------------------- -----------•---------------•------------=----------------- ---------1-------------- -=----------- - --------• --------------------------•------ •- ------- -----•-------------••------•---------------------------•-- --------------z.------------------------------•---------••-,----------------------------------------------------------------------------------------------- FINAL INSPECTION BY:- -<- Date /-"_7-`_ --------------------------------------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT ` 1401 E.Hazetton Ave. , 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS`9 REVISED 6-59 3M 3-'63 F.P.Cd. \ S