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E FOR OFFICE USE: l ` 5I�" � Permit No. .. ... ------------ ----------- ------------ APPLICATION .FOA SANITATION PERMIT ---------------------------- ------ ------------ (Complete in-Duplicate) Date Issued ._ - -- -� --- ------------_---------------___.--- ---------------- i This Permit Expires 1 Year From Date Issued _ /?0,5.6 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 Count Ordinance No. 549. d JOB ADDRESS'AND LOC TION -------- �j 'Ower's Na e__S __4'�� ' '` QQ -------------j--------R--------=------------------------------------------- Phon n -- ---- r s Address_...-- v' #---------------------- ------- --------------------------------------------------- --ON ---------- ------------------------------------- e U e�Pr c% - •--- Contractor's Nam l ._� " FIF"-9 t f �'.✓--------- Phon __ Installation will serve: -Residence gj4partment House ElCommercial E] Trailer Court ElMotel [:] Other [3 Number of living units: -j---Number of bedrooms _3 Number of b hs _/---- Lot size c � l Water Supply: Public system ElCommunity system ❑ Private Depth to Water Table/70ft. Character of soil to a depth of 3 feet: Sand-❑ Gravel [jSandy Loam E] Clay Loam E] Clay [IAdobe Hardpan C W Previous Application Made: (if yes,d .. ate- _--_-h-,__------I No ❑ New Construction: Yes ❑ Na-j /VA: Yes E] No El✓ �\ TYPE:;OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) w o—s ?- �T�"�•��Di s t ance from nearest well-----------------Distance from foundation-------------------Material_._____-.-.--_.---_-_-_ -----_--__---_-.._©---__-__ is rM7 .1 , .1N°''°f compartments - -------- - - ..Size__ _-----------------• ----Liquid depth_---.__----_- - -_----Capacity----------------------- ._ stan - arest weil.IQO-------Distance from foundation---/_49. ...._.Distance to nearest lot line---� '--Number of1lines-----/---- Length of each iine__.Z� ---------°---Width of trench._.�i4�---------------------- �-�r-,Type of filter material_______ � -Depth of,filter material------ ..Total length--------�..�___----____________ .' I ffoundation---- 'Number ------- Distance to nearest lot line_ --- __ Seepage Pit: Distance to neares well�_�©__._.______Distance from foundation____ Number of'pits._I'.----------------Lining material_RA_c_�_.___._Size: Diameter__ -__ « .__Depth...- -.rr_.____ Cesspool: Distance from nearest well-----------------Distance from foundation.------------------ Lining material--..----.-------__--_.--_ __..._____ ❑ Size: Diameter------------------ -------------------Depth--------------;�------------------- -------------Liquid Capacity----------------------------gal Privy: Distance from Nearest well----------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line---------- ----------------------------- ----------------------------•-- ----------------------------------------------------------- -- --------------------- ----------------------------------------- . t + - Remodeling and/or repairing (desctbe)----------------------------------------------------------------- -------- -------•------ --------- ---------------- - --------k------------------------------------------------------- -� ---------------------•---------- ---------....----------------- ----1 ----------------------------------------------- fon_ : _ ' I, hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co ordinances, State laws, and rules and regulations of the San Joaquin Local Health District: 1 r' , [2 4 s -- ------------------- �j' r Contractor) s l ---__._Title-- ---------------------- - ----'-------------- - - (Plot plan, showing size of.lot, location of system in relation to w Is,.building fe can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- _ ... -- - -=-�x�.--�—•------- ------=�----=----------------------------- DATE-- X71------------�--------+ - - ------------- .._- REVIEWEDBY------------------------- ----------------'----------- DATE BUILDINGPERMIT ISSUED--------------- ------------------------------------- ----------------------------------------------- DATE----------t------------ ------------------------------------ Alterations and/or recommendations: ...... �-`---- ---- -------- `-`' �- . ----Y�``� `-` ------------`--mil - --�----"'^------------------------------------------------------------------------- -------------- --------------- -------------------------------- ------ --�-- = = ---------------------------------------- FINAL INSPECTION BY---------------------- ----------------------------------------- Date.... �--- . n SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th street Stockton,Callfnrnia Lodi,California Manteca,California Tracy,California ES 9 REV1S50 8.59 3M 3-'63 F.P.CO.