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FOR OFFICE USE: 7y G ------ --- ------ --q v — -- -----___._____-----------------),_-------- ------------- APPLICATION FOR-SANITATION PERMIT Permit No. i (Complete in-Duplicate) 44 --- ------------------------------------ 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 with County Ordinance No. 549. `'�` L JOB ADDRESS AND L TION_:;--_�--_._ --- Owners Name----- -- - ----- ---------------------- ----------------------------------- --------- Phone------------------------------------ 8 Address----- 6G2 -__::- - r1 `---•- -3 °•. I I Contractor's .Name - ------- -------•--------------------------------------------------- ------------------------ --------------- Phone t � Installation will serve: Residence ❑ Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑-�—' , Number of living units: ________`Number of bedrooms -------- Number of baths _I–__ Lot size :1__r�_�__f$__7r-7S _____________________ Water Supply: ,Public system,G Fommunity system ❑ Private ❑ Depth to Water Table tP__ ft. Character of soil to a depth of 3 feet: Sand ❑? Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan El Previous Application Made: {lf yes,date------- ---- ------_) No New Construction: Yes Dq`�`No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ I Septic T nk: Distance from nearest well__-r-------- ---Distance from foundation__'r-------------Material___- -_---. j No_ of compartments___'_',________________BileLiquid depth__--- _-__-.-.--_---__Capacity__1260-__ _ Disposal Field:, Distance from nearest well-`----_______Dist6nct from foundation---/Q--_ -____-Distance to nearest lot line... Number of lines_-1__.- ------------ Length of each hne___-T�_- ..._.._.-_-Width of french ;,Z_!%-_''_____-____--_---___ Type of filter material�pt,.�.______Depth of filter material_rfj"____---------Total length--____f'IX'[�__�________________-_ j Seepage Pit: Distance to nearest well------ ---___----Distance from foundation----jJf__t_____-_.Dist4nce to nearest lot line-7�r� j Number of pits--------- Lining Material____f�0_C 1t_-Size: DiametWl------------------Depth__.e � __ Cesspool.,, Distanceifrom nearest welL__i_____________Distance from foundation---____-------------Lining material--..--------------------------------- ❑ Size: Diameter-- = ----------------------------- ---------------------------------------------------- ---- DepthLiquid Capacity-------------------- -------gals. t _ r Privy: ( Distance from nearest ------------------------------------------Distance from nearest building------------------------------------------ [❑ Distance to nearest lot line-------------------------------------------------------------------------------------- ---------- ------------------------------- t � Remodelingand/or repairing (describe):-- ------ -------------------------------------------------------------------------------------- ------------------------------------• ------------------ ________________4____-__________-________________________..__________________-_______-._--_____________________-_________________-_____--____-_____________-_-_--________-____--______-_-_______________--.--_--_-__________--- i --------------- -___-_______-_____--------------------------I J _ _-__-__________________________________________________________--____-._____-_______________-_______-_________________-___________-__--______-.___________--____ j ------------------------------------- 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) I By:------`-`---- --------- - ----- ------- -------------------------------------------------------•----------•-__•_--_•___(Title)------- --------- ------------------------- - - ------------ (Plot'plari, showing size of.lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ... .. {� R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------ ---------------- ---------------------------------------- DATE-------- 7-6._t ` ----------------------------- REVIEWEDBY--- ------------- ----------- ------------------------------ ------------------------------------- DATE --------------- BUILDING PERMIT ISSUED--` ATE Alterations and/or,recommeridations:.- -----,> -- -------��-- = - --_--`-:-- ------------------------------------------ ------------------- z=� 4 -- ------------- --------- =��$ FINAL INSPECTION BY:- - - - --- ------------- Date-----7--/5-i6 S J UIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave- 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California I F.P.CO.