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rUrc Url-If—L USt: ,--/ ------ ---------------- -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ......_. __..._. -. ---------------------------------------- ---------------- (Complete in Duplicate) -------------- ------------------------------ This Permit Ex ices 1 Year From Date Issued Date Issued .__ _� �__�`" Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal the worherein described. This application is made in compliance with County Ordinance No. 549x1- r SLG�S JJ,4,��t Ssrty5'• SIDS- I � 1� JOB DDRESS AND LOATION---------------NARC�1_c��`` _ _ 'i __.Q[^--- Jo H tq ------...-------------- Owner's. Name------------- _ -------- x.. 1.11--------------------- -------------------------- ---------- ----- Phone Address---------------- ('D T 2`..` ryi Contractor's Name. 'H _PA�- 1.P1 �--_ .. __N .I 7 - = ` Phone ------------------------ Installation will serve: Residence Apartment House [I Commercial I] Trader Court El Motel E] Other E](dumber of living units: __/___ Number of bedrooms __3__ Number of baths _ _._-_ Lot size_..... C._ Water Supply: Public system ❑ Community system [] Private �Depth to Water Table 3_51i. Character of soil to a depth of 3 feet:- Sand ffi Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application'Made: (If yes,date_-_ ---------------I No RT" New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: A..-- (No septic tank or cesspool permitted-if public sewer is available within,200 feet.) Septic Tank: Distance from nearest well_________________Distance from T,undation--------------------Material----. Ui` E�&jGT-1 KG— No. of compartments------------------------t Size------------•---{------ +.Liquid depth--------------------------Capacity 7"Z,-_« Disposal Field: Distance from nearest well----IS ..'LDistance fromt,founda+ion-----/ .......Distance to nearest lot line_____.��-- � F_US'T-1KG Number of lines____-_'__�------' --------------r Length of each line______._73Q-_-r_____._.Width of trench___.___Z - _" � p Type of filter material----.�G'-C_K._-Depth of filter material__-----/_r� ....... � f----- ---Total length---------- ---- -C_-1<- ------•----- � Seepage _____Distance from foundation__._,��Pit: Distance to nearest _ well_______ _ ---------- _........ Distance to nearest lot line_____.-____._ 59-- Number of pits-------I-------------Lining material__POCK_--..Size: Diameter-_�--X--'7----Depth_---_-f - ------------------ Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material--------------------- ' ❑ Size: Diameter --------------------- Capacity----------------------------gals. t Privy: Distance from nearest.well-., __________ _______________------Distance from nearest❑ building N Distance to nearest lot line-------------------------------------------------------------•- Remodeling and/or repairing (describe)----------------------------------------------------------------- ------------------------------------------------------------------I -------------------------------------------------------•----------------------------•------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I ha v epared this application and that the work will be done in accordance with San Joaquin County ordinances, S ate laws, a and reg lations of the San Joaquin Local Health District. (Signed)4/ --------------- :r ------ --------- - '------------- -_------------------------------- ---?--(Owner and/or Contractor) By' -•------•--------•-•--------••-------••----------•--------------- -- Title __ - ----------- --------------------------- - of pan; showing 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_.._---_'� 1._�_�o� DATE--------- ..r � _ _ REVIEWEDBY---- -------------------- ---------------- --------------- ---------._ DATE ---- ------el ------------------------------------------------ - ------------------ UILDING PERMIT ISSUED----- ------------------------------- - --- - ------- ...---- •---- DATE--------------- - - - - - - ------------------------------- Alterations and/or recommendations:__-- -!f ---- tJ --- -------- [ C`QUr --____ _____-` -f._ ------------------------------------•----------------------------------------- •-----------------------------•------------------------- ---------------------------------------- ------------------------------------- -- ------ -- ----- ------------_P -- { ••------------------•-- --------------------------- ----------- ---------- FINAL INSPEC Dat e-"_------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California REVISED 8-59 31A a-'63 F.P.CC.