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- --- FUK ,F�F.hCE USE: -Y _ APPLICATION FOR SANITATION PERMIT Permit No. 1749 ''... --------------- - --- - ------- ---------µ------ ------------ Duplicate) -------- ------- - .(Complete in Du Date lssued,�___ - - ---- -------------" ------- .-- � This Permit Expires 1 Year From Date Issued 2�7=--�y 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 L-OyCATION `.... ..-�._. = = �--�----------------------- Owner's'Name__._- -�. 1--��✓y -----•---------- - - Phone -----•---- Address. 1d0,17_t.--'0 ------•--••----------•- Contractor's -Name-------. __a_ __cam-__.___ �- _ ------- •------------------------------------------------------ -- •-----------•-------- Phone-------•----•---�---------••-- Installation will serve: Residence © Apartment House ❑ Comrriercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/ Number of bedrooms ._�3__: Number of baths Lot size - --------------------------- Water ____________ '----._____Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table 4.-'7ft. Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: (If yes,ddte____________________j No �ew Construction: Yes J�o ❑, FHA/VA: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No,septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic TAA Distance from nearest well------ __:•:__Distance from foundation__f_ ___.-____..Material__Cfn___(?__2-1__.C-:_1(-'_ No. of compartments------ ----------------Size ^_.!-6-1_�,/.j2:_---.Liquid d`th Capacity---L_adc2------ Disposal field: Distance from nearest well------ ' - Distance fromloundation �*h__.._-____..Distance to nearest lot ---- g Number ofz'llnes _ a--------------------Len fI of each li �/ ' _ __�_ -..Width of trench..�_'f__._ Type of fii;tar matergal__-_1_J.�___]?,eGWDepth of filter material----.1__l�-___............Total length_._f, _! r yP .Ii Seepag it: Distance #o nearest well__ --_- Distance-from foundation—./—(� � Qis#ante to nearest lot line-5- ----- _ -- Number'of pits .1---------Lining material`_ t? _�- ----Size: Diameter . `! Depth___ _�_�_ta- c ' *' Cesspool ' f?istance fi-om, riea esf�rvell_____ _ _______Dista ce,from fTd'aon ...___._ T...Lining material----------------- © ; . Size: Diameter----- _ s `Qep+h = ' ` --------- Liquid Capacity -----------gal ')'rlvy i' ) ; .Distance from nearest well-__._ --------------------------Distance from nearest building Distance to nearest lot line- -_----- p ❑ ---------------- ----------------------------------- ----------------- ---- k'• - Remodeling and/or repairing (describe):---------------------------- tea-`' t o Qr 1 --------- `F �` ( -------------------- -7---------------------•---------- ---------------------------------.------------- ?`----- 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 pules and-regu ations o `the San Jaaquin LocalwHia—ItIFDisf�ict:-- ---- --------- --- --1 C3--------- # �- -- --------------------- (Signed) ' 1 -- _ a �,: --------- - - - - ---------- � -Owner and/or Contractor) (Plat Ian, showing size ------(Title)------0 p g e of lot, location o sy tem in relation to -12 buildings, etc., can lJe placed on reverse side). FOR'pEPARTMENT.USE ONLY APPLICATION ACCEPTED .BY---- G '- - = = : IDATE_ `� �2 ------ REVIEWED BY - -------------------- ATE - - - BUILDING PERMIT ISSUED------------------------- -- - - --- ---------- Alterations and�or recommendafiians:_._:_.�. �L l --- t r��_- :�_L ��-- �-----�7 - ----------------- -- ------ ='_ .rev` ` . ---------------------- ------------------ -------- ------------ _--------------------••------------ ------------------------------ ------ ----^----------------- FINAL INSPECTION BY:------ .- --- ` -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maseiton Ave. 300 W 1 est.Ciak Street k! 124 Sycamore Street 205 West 9+h Street f i1 r`y Stockton,California j , f?Lodi,'California/ f Manteca,California y. Tracy,California E5 9 REVISED S-59 3M 3-'63 F.P.Ca. -