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FOR OFFICE USE: ------ -------------------------------------------------- APPLICATION FOR SANITATION..PERMIT Permit No. . _._7 -- -------------- --_._, (Complete in Duplicate) Date Issued _GA$7/0 - -------- ----------- - ---.--- --------- This Permit Expires 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 in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCCATION__�J��..�--�- --- -� --{ NQ---_6.RAK�------------------------•I _N_T C. ------------ Owner's Name-------L-- !--__' OBR- -••-•----•----------------------------- - ----------------------------=- ----------- Phone----------------------------------- ------S.P15 .. 11 114_ RA_NT �V1f1J`�I`_c_A-----------------------------------------------------------•------------------- Contractor's Name--Q----- CAR6_1_44�i -•------ -------------------------------------- Phone..._.... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [}� Number of living units; _ Number of bedrooms �___ .-4--- Number of baths _&__ Lot size ----------------------------------------------------------- Water Supply: Public system ❑ Community system Or"lPrivate ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [I Previous Application Made: (If yes,date..................1 NoE"' New Construction: Yes e No E] FHA/VA: Yes E] No TYPE OF INSTALLATION AND;SPECIFICATIONS: t� (No septic tank or cesspool permitted if public sewer-isiavailable,within 200 feet.). Septic Tank: Distance from nearest'well__:__.__.'_-_----_Distance from foundation_---_:-----.-_.___ aterial__________________ ------------------------------ � LLWid F_Xl�Tj f4 C.--.. No. of compartments--------------------------Size-----••---�--�--------------- de ------------ -------------Capacity----------------------- per' t Disposal Field: Distance from nearest'weli__"!"....;...Distance from foundation--- ---------'Distance to nearest lot line i__________._.. � f XG` Number of lines_.�.a____ ___ - Length of each line___-_-_�,� Width of trench._____-- v-----------•-� 1-X�6T = � ---- yy &D D, Type of filter materiaL��QC -_�---Depth of filter material__:.---3(2_____--Total length----------7,5 --------•----------- N Seepage Pit: Distance to nearest well-___-_____________---Distance from foundation_-..___...____--___.Distance to nearest lot line------------------ ❑ Number of pits-=--------------- Lining-materisal---------=----------- Sizer Diameter----------------- Depth N Cesspool: Distance from nearest well-------.---------Distance from foundation--- Lining material_---__._._._----______._______--___ ❑ Size: Diameter---- --------------------------------Depth- r_-----------------------------------------------Liquid Capacity----------------------------gals. r � m Privy: Distance from nearest 'Well---------�----- ------•---------------_•- ___Distance;fronearest building----- ----------------------------------- I ;-r ❑ Distan to nearest lot line--------------- ---------------------------- -------------------------------------------------------- t Remodelin and/or re airin escri e :-_ __._- FRoA4_____6ARB�----f- __AJPfiTlQnls. T'RL�L__ ,T4s.--------------------AYA>!+--R_i3�.. �R�_D__-- JS - y & _- t ----- ----- �� ---- f __----- t 4 ©R F --------------------------------------- --------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e�laws, and rules an egulations of the San Joaquin Local Health District. �a [Signed) k -�`�( ---------=----=------------------------_--------------- (Owner and/or Contractor) ---- -- Title-------------------------- By---------------- {t ( ) (Plot plan, 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--------.[._.�.-R-0- ------------ ----------- DATE �`� ------------------------- REVIEWEDBY--------------------------------- --------------------------------------- DATE------------------------------ ------•---------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------•----------------------- --------------------- Alterations and/or recommendations:---------------- ---------- -------------------------------------------------•-------------------------- ----------------------------------------------------------------------------- --------------------------- L FINAL 1N5PEC Date------------46 r c SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3oo West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California rS 9 REVISED 8-59 3M 3-'63 F.P.0 .