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FOR OFFICE PSE: APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------- ../�f ... ---------------------- -- ---- : Date Issued ------------ 3 ------- (Complete in Duplicate) -------- ---------------- ----------- 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 wit County Ordinance No. 549. JOB ADDRESS AND LOCATION- D --------- � �� Q • •- ---------- Phone G-'7�s'. � Owners Name-----�1w.'----- ------------ _-•------------- - ------=--------------------------------------------------- Address----------------/- -----------e•-•--•--X11✓-+ .Cs _.Z;-- ------------ ----------------------------------------------------------•---------------------- Contractor's Name------ . 7_:._1_ x =J ------ .SCg/! / Cy------------•----- Phone. ----- V, Installation will serve: Residence ©- Apartment House ❑. Commercial ❑ .Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ - Number of bedrooms __' Number of baths ---L_-_ Lot size -------,/_------ —________________________ Water Supply: Public:system [a' Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam B' Clay ❑ Adobe I/ Hardpan Previous Application Made: (If yes,date__________I----------)-„N o � New Construction: Yes E] No El” FHA/VA: Yes F1 No O TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation___________________Material----------------------------------------____-._- 0 No. of compartments-------------------------Size-----------------------------:--Liquid depth-------------- ------ Capacity_•------------------- Disposal Field: Distance from nearest well_AVAN _Distance from foundation____Zb._*------Distance to nearest lot line......S...__.__- "6 Number of lines-----------/--------- ___Length of each line-------__Y4__......-------Width of french____________ _1 _"'__________I -Type.of filter material____h'�Q 1_�___Depth of filter material-----_Z, _ --- otal length_______________________'iffd_�______ p g Distance to nearest well_-N�^a4.---Distance from foundation____jQ__!.___.Distance to nearest lot line_-_.5`.�__._ a Number of'.pits___-: ._�_________Lining material___R�<<.---Size: Diameter....�C�q..--_____.Depth--._-_-_.-_�_c,�__.'_.______ ee age it Cesspool: Distance from nearest well'--------------Distance from foundation_._----------------Lining material------------------------------------- ❑ Size: Diameter------- ------------------------------Dept h----------------------------------------------------Liquid Capacity-_------------------------gals. 4 Privy: ._ Distance from nearest,well-------,-,, --------------------------------------Distance from nearest building.-_______________________________________. ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------- ------------- } Remodeling and/or repairing' (describe):-----41,1---------7�--------AJC -------------------- -' ----------•---------- ---•--- ------------------------------ ------------------------------ ---------------•----------------------------------------------------------------------. ------•---------------------------------------- ------------------------------------ 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 regulations of the San Joaquin Local Health District. 1 t f Si ned s •_ .__ _ /- x?` --------------------------------------------- {Owner and/or Contractor) r y. .-5 -a' 1. ,a,e._ r - Title k�-'- -fir ------ ------------ - -------- (Kot plan, showing size of lot, locgtlon of,,sysfem„in.,rAation to-wells, buildings, etc., can be placed on reverse side). USE ONLY 'APPLICATION ACCEPTED' ------------------------------------ ' ' DATE-- � --------/------�-:------------- ------- ---- REVIEWEDBY_ . - -------- ----------- -------------------------------------- ��.. ` t� DATE BU&MOn PERMIT ISSUImen `_ `� -------------------------------- Aiterat+,ons and/or recommendations . �c—zt - - � - ----------- - �--- �------- •-•--------- �-- �., ---- ------- -------- --------- ---- ` ." ---------------------------- ------------------------ ----------'--- -t-----c� + �� -- �_^c_: ';�7-- ------�-_- ----------------'------------- ---------------------- - Z-. ------------ ----------- •----------------------- ------------------------------------------------------------ GT T_ /01 FINAL INSPECTION BY:............ Dafie- - = I � � s . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 43 Stockton,California i Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3M 3•'63 F'-P•C R. 2y i