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FOR OFFICE WSE: f /y - ---------------------------------- APPLICATION FM SANITATION PERMIT- Permit No. _/kZs- ---------------------------------------------- ------------ (Complete in Duplicate), ,DateI -issued ------------------------------------....y--------------- This Permit Expires I Year From Date Issued Application is herebmade 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. oao— 77 V� JOB ADDRESS AND LOCATION..., Owner's Name & ---------------------------- ------- ------------------------------------ Phone-------------------------4---------- Address----------&r/?rK 0K------ ------ - -------------------.............. .......... Contractor's Name----------- - - -- ------- - - - -- - ----------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Z?O"Apartment House E] Commercial El Trailer Court E] Motel!1 0 Other ❑ Number of living units: Number of bedrooms Number of baths--?-- Lot size 11' ----------------------------------- Water Supply: Public system 0 Community system E] Private El Depth to Wafer Table AW ft. Character of soil to a depth of 3 feet-� Sand [] Gravel [] Sandy Loam 0 Clay Loam 0 Clay 0 1: Adobe 9?---Hardpan 0 Previous Application Made: (if yes,date -------------- __.) -No L94--New Construction: Yes �o 0 ❑ FHA/VA: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: V1 (No septic tank or cesspool periiffed if public sewer is available within 200 feet.) tV� a ce from founclatic ---------Mi. Septic Tank: Distance .from nearest well___7e__.--- Dist aferial---- No. of compartments----------------'Size -`?. 9 Liquid depth__-.4!1r_: ---------41-7capacity- Disposal Field: Distance from nearest well--- _.-Distance from foundafi9_.4 .... -nDistance to!: nearest lot line- Number of lines --- Length of each line___F__9e1 -------------)�idfh of t�i Inch-A---------------------- Type of filter maf4`riaI_/4.;r,&0, -Depth of filter material_--AP?�------Total Iengtd1____./"____1------------------- Seepage Pit: Distance to nearest weil----10_��dp-'-Distance f foundation__"__ ___" D' to ice tolnearest lot line__-_2�--- Number of pits---- --- -------Lining material__A�U;e_ ---Size: Diamete -- ----------bepth--.2%$ --- Cesspool: Distance from nearest well-----------------Distance from foundation____-..-------.---_ Lining mafeilrial-------- ----------------------------- ❑ Size: Diameter------ ------------------ -------Depth------- --------------------------------------------Liquid CapAcity----------------------------gals, Privy: Distance from,nehrest well-------------------------------------------------Distance from nearest b0din�--------------------------------------- 0 Distance to nearest lot line------------------------- ------------------------------------ -------I-------------------------------------------------------------------- - Remodeling and/or repairing (describe): -------- ------------ - .14 - ,e):-------- - I-, --- ------------------------------------------- --------------------------------------------------------------------------------------------------- ------------------------------------------:---------------------- ------------- -------------------- -------------------------•------------------------------- ------------------------------------------------------------------------------------------------ ------------------------------- ------------------------------------------------------------------------------------ ------------------------------------------ ----------------------------------------------------11------------------------------------- I hereby certify that I have prepared this application and that the work will be done,in accordance with San Joaquin County ordinances, State laws, and rules and ri'7ulafions of the San Joaquin Local Health District. (Signed)--------------- ----- --- ---------------------------------- ---- -- nert�mtdAei Contractor) BY------------------------------------------------`----------------------- ---- ----------------(Title)-- - -------------------------- -- r ion to (Plot plan, showing size of lot, location.of system in buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- .........................a---------------------------- DATE-------- r - - -- - � I - C-- ------------ REVIEWED BY------------------------------- ------------------------ DATE----------- ----I ------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------7---------- --- DATE.-- ------------ 'I------------------------------------------ Alterations and/or recommeP -ndati -------- ---- ons:---------------------------------------------------------------- ----------- ---- - ----- --------------- --------------------- 411-3 ----- ------------ ------------------- 7---------- ------------------------- ----------------------------- --- ------------ ---------- ------------------- ----------------------- --- ------------------------ -- ---------------------------------- -------- ----- --------- --- - ------------------------------------------------------------------------- ----------------------------------------------------------------- ----------------------------- ----------- n� FINAL' INSPECTION BY:.----- -- ---------------------- Date-------- C--- ---------------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street mi west WIN Street Stockton,California Lodi,California Manteca,California j Tracy,California ES 9 REVISED 8-59 3M :3--65 F.F.100,