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F R OFFICE USE: x. r:. l_ _ �_.________________ - -S,-- APPLICATION FOR SANITATION PERMIT Permit No. ---17-G l; [ (Complete in Duplicate) r Date Issued --_ �1 _ G This Permit Ex ires 1 Year From Date Issued a' -/ Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOS ADDRESS AND LOCATION E----------- -P --------------------- ------- a Address - lz�><�rc. n C�L -sir•1 ----------------= 5��'J-`11 b'L� Owners Name-----' �, ---------- ------ Phone-- ---------------••-------------- Contractor's Name---------- .Klt2 . Installation will serve: Residence x Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ f Number of living units:,--)__-. Number of bedrooms __'�._ Number of baths __ __ Lot size ---/G-R'�-.-__ La'-________________._'____ Water Supply: Public.system*X Community system ❑ Private ❑ Depth to Water Table _� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date----------- ------) Nox New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No,2 f 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---------_----------Material--------------------------------------- --------- 0 ---_.❑ No. of compartments--------let--------------Size--------------------------------Liquid depth-_------------------------Capacity------- ---•----------- Disposal Field: Distance from nearest well_?:Distance from foundation----/,0_1-------Distance to nearest lot line.._ -- Number of lines-•-•--------- - �- --�- Length of each line-_---__-K'----. ___Width of trench-____-_---s-`-_____----. P� Tse of filterteral ,- Depth of filter material_-__.-,! :_" ___Total length------------------- CFOSeepage Diarice to nearest well_�e_ ___Distance from foul dationDistance to nearest lot line_.--_' �_.__ „J Number of 'its --___Lining material-:. � �tf.-- �} .Size: Diameter--- --` - *3G-"*Depth-----------W.--------------- L�f,6l Cesspool _ Distance fiom nearest well-----------------Distance from foundation-------- ------------Lining material----_.------------------------------- Size: biameter---------------------- ------_----._--_----.__------.Size:Diameter---------------------- ----- Depth----------------------------- ----------------------Liquid Capacity------------------------:...gals. Privy: Distance from nearest well-------------------------------- ------------ -Distance from nearest building;_----------------------------_-----___-- -~� w ❑ Distance to nearest lot line.__. --------------------------- ---------- --------------------------------------------------- Remodeling ------------------------------------- ---------Remodeling and/or repairing (describe):-------- Zck--- -�,,,y� -c.�CF-�i ..__ __fes tom - ------ ---------- ------------ ------- t ---------------------------•---------------------------=------------------•--•-------------------------------•----------------------------- ----------- ----------- - --------------•--------------------------------------------------------------------------------------------------------------------------------------------- ------- --------•-- '-`--------------------------- 4, ------------------•-------, 4 ' ---- -._ --,--------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done-in accord: ance with San Joaquin County ordinances, State laws, and ruleond regulations of the San Joaquin Local Health District. ) I (Signed)o . - -- (O ner and/or Contractor)----- -------------- - By:... ------ - (Title)-------`. ' ' (Plot plan, showing t size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY r '1—=--------------------------------- ---- DATE----- 1 REVIEWED •S -------------------------- ---�- -------- ------------------------------------------------------ DATE-----------'------ BUILDING PERMIT ISSUED-------------------------------------' i- - \-------- DATE------t=------------ , Alterations and/or recommendations -- 1 _- � _-�t..T---------- `'' ---------•-�---L'ca—c:-— --- ------- -:- ------------------------ ----- ----"----•---•=----------------------------- } --------------------- ------ - --------- -----------------------------------------"---------- FINAL INSPECTION BY:..-.�_j�_---- -- - .C' 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 ES 9 REVISED 9.59 3M 3-'63 F.P.CO. l