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= I F R OFFICE USE: _-- --------- /, ______------- --- APPLICATION =AOR SANITATION PERMIT Permit No. . - .f . --------------- ------ --------------- ----------- --- (Complete in Duplicate) ----------------------------------- - // -------------------_-----_--------------_____.._.___ _.- This Permit Expires 1 Year From Date Issued Date Issued ----714 -_fo_ 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 LOCATION f � / f� �� - --- - /-0 _4 -...... Owner s Name/ � ------•------------------------- ----------------------------- Phone Address------- -------------------------- ---------------------------------------------------------------------------------..--------- 7 Contractor's Name---------- '/ - Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-- Number of bedrooms _...2__ Number of baths A--- Lot size ----------------------------- Water Supply'. Public system ❑ Community system ❑ Private Er'�bepth to Water Table "4' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_..--------,_..----) No JR' New Construction: Yes ❑ No R?--FHA/VA: Yes ❑ No R;4-- TYPE OF INSTALLATION AND SPECIFICATIONS: 33 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' 1 Se tic Tank:. Distance from nearest well--_------__:_--_Distance from foundation-------------_-- Material--_--.------_.------..------_----.-----------_-- ,r f�z,� No. of compartments---------------------- - Size---------- ---------------------Liquid depth---------------- ------ -Capacity-------------- --`--- Disposal Field: Distance from nearest well. e__.._-__-Distance from foundation -------- Distance to nearest lot line_f ________ Number of lines------- -_/____ Length of each line._t _.�_. _____ Width of trench.----------------------------- -/ yJ- / . ' Type of filter material ___� _ � Depth of filter materia!____.__ .__. Total leng#h_-�__________________.______._ F11 Seepage Pit; Distance to nearest well-.--` ___Distance fr fouudation--.� .--_-.Dista to nearest lot line-/ -_---_-_-- Number of pits-_-.�.------_..-.Lining material_-_ /�-_Size: Diameter__ _-_.Depth.. __ ______________ Cesspool: Distance from nearest well---------- ------Distance from foundation--------------------Lining material----._._____-------.---..---__-.--_- 1P ❑ Size: Diameter------------ -------------------------Depth--------------------- •-------------- -------------Liquid Capacity---------------------------gals.. Privy: Distance from nearest well ------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line---------------------------- -a ------------------------------------------------------ --------------------------------- -------- e Remodelingand or repairing -------- ------ -- - - -------- . . II . . - ------- ------------------------------------------------------------------------------------------- , ------------------------------------------ I ----------------------------------------------------------------------- ----------------------- ------ 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 W�ullesandgulations of the San Joaquin Local Health District. (Signed)----------- ----------------------- ---- --- -- - `� --------------------------------(�lor Contractor( 0 g 'z r (Title)- %40_e-?�,' j (Plot plan, showing size of lot, location of.system in relati o wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____ i -- DATE-- Z " REVIEWEDBY -------------------------------------------------------------------------._ DATE ----------- - - ` --- BUILDING PERMIT ISSUED---------_- -------- G DATE-------------- --------------- --•---------------- ---------------- _ IAlterations and/or recommendations:-_-----. ._.- I ---------------------------------- - - --------------------------------------------- - --- ----- -- ----------•------------------------------------------------------• - -------- --------•-••----------------- -- ----- ------------ ---------- - -- ------ ---- --------------------------- ------------------------------------------ ------------------•----------------------------------------------------- --------- -------------- ---------------------------------- ------------------------------------ '--------------------------------- t -- -------------------------- --------------------------------•------ ------ ----------------------;------- -------------------------- i � r FINAL INSPECTION BY .........CL -7, ------------- Date_.'7- ------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT ( 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ( Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O. t