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FOR OFFICE USE: +' --------- -- -------------------------------------------- _------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------- ----------- -- (Complete in Duplicate) Date Issued --�- L/_� A? = �`l lPar�?.--f -'-..... ..... This Permit Ex ires 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 lin_compliance with County Ordinance No. 549. 1 DON �j JOB ADDRESS AND LOCATIO ____________ __ -___.__ ._ �' �i_i_Pa_ ( �- 1 'ti fi ---------------------- Owner's Name-------------------•FRaN-K------- --Fk-�_J---Th-�� --- -------------- --- Phone- ------------ -4y------------ Address-------------- Q©-X- `� �- -�_ CJ/ _ l� _� .-......•--•------•----------------------- Contractor's Name--E---•-f�-�T�_t�1V ----•--'��---...�----1x_�--------------•-------------------- Installation will serve: Residence ❑ Apartment House❑Somme coal.❑ Trailerourt ❑ Motela❑ Other ❑ it } ^1h ' 1 .` 'ii" t ,-`� Number of living units:.-.-I-- Number,` bedrooms_7- Number of baths ________jLot size _.-- G1 .>r _.L ...-__-__---------------- Water Supply: Public system ❑ Community system ❑9 Private Depth to Water Table J57-ft.Character of soil to a depth of 3 feet: San d � Grave ❑ Sandy Loam El Clay LI a` ❑, ay ❑ Adobe E] Hardpan ❑'' Previous Application Made: [If yes,dote----- __-----__.] No New Construction: Yes `❑� No 0 FHA/VA: Yes ❑ No R�- TYPE OF INSTALLATION AND SPEC IFIIGATIONS: [No septic tank or cesspool permitted if public sewer is-available within-200 feet.} 1 ' Septic Tank: Distance from nearest well---- _____Distance from foundation_--_-_� No. of compartments_..__ ____.._..__Size_y 1_ __ __ ___.___Liquid de 6.1�----- ��.,_...Capacity_..I2-V_CP_. P Number of lines------------ ell:__ _C --.-Distance from foundation------tO- --_.Distance to nearest lot line---- ---------- Dis o field: Distance from nearest w Length of each line___ __ _�s �.Width of french-_____.�Z__�_-------------------- Seepage �_ _------------ Type -- - - -------- T e of filter material,_._i U_C._ Depth of filter material_- r` Total length----_-_-..-M-0--__--__--__--_. i Seepage Pit: Distance to nearest well'A____--- --Distance,fromtfound on----_ t----------Distance to nearest lot line----------------- h ❑ Number of pits-------------------_Lining-mater`ialN%-----------------Size: Diameter------------------------Depth----_---------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------.-------------Lining material-------------------------------------- Size: Diameter-----_-__-- ❑ --------------De Pth__._-_--____-. _--------------------- --------------Liquid Capacity--- ------------------------gals. fi Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------_--------_-___-----_-__----. +�) Distanceto nearest lot line --------------- --------------------------------------------------------------------------------------------•-------------------- Remodelingand/or repairing (describe):---------------------------------------------------------------•-------------------•-•-------------------------------------------- ..................... Q 3 ; ---------------------------------------------------------•---------------------------------'-------------------------------------•-------------------------------------------1----------------------------------------'--- -----•-------------------------------`----------T I hereby certify that 1 have prepared this application and that the work will be done in accordance.with San Joaquin County Jv ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. a D � [SignedI --------------------------------------------------------•------------- _ }---------�--�I��____-- _ �'p� -- - ---Ch"C. ',[Owner and/or Contractor) El . rlf__rC� 1G? ' r' Title -! ----------- Y' - ' [ } -- ------------- (Plot plan, showing size of lot,lo`catio tf cr# ystem in relation to Wells, buildings, etc., can be placed on everse side). FOR DEPARTMENT USE ONLY" t APPLICATION ACCEPTED BY-----.- -FI-R-0 --------------- --------------------------------------- DATE------ - REVIEWED8Y----- ------ --- ----------------------------------------------- - -- ------- ---- --------------------------------- DATE---- --- ------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------------------jlk DATE------------------------------------------- --------------- Alterations and/or recommendations--------------- ----------------------------------------------------•-----------------------------------•--------------••--------------------------------------- ----------------------------------- •-------------------------•-----•-------ems; -------------------------------------------------------------------------------------11---------------------------------------- --------------------------------------- ------------ ----.------ --------- -----------•- ---- :.------------------ ------ t ------------------------------------------ ----------------- ---- ------- -------;-------•- ---- ----•--.- •---------------------------------------- -------------------------- FINAL WSPECTION 6 �1 Date------- ------/ R SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak'Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-$9 3M 3-'63 F.F.CD.