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FOR OFFICE USE: ---------------------------- ---------------- _---`.�__- :�----------- -- ---- ------- APPLICATION FOR SANITATI(,.4 PERMIT Permit No. _101F (Complete in Duplicate) �� ` This Permit Expires l Year From Date Issued Date Issued .___ ____ ..A _.. 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 Ordinanp49. JOB ADDRESS A LOCATI r `� - t Owner's Name r <7G� + t. fl.�� ---- -- ------ - Phone-_,,..�._(p'Z---d_-��"°��9 3,7� / Address------------------------ Contractor's Na ____ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: __*- Number of bedrooms ________ Number of baths -------- Lot size -______7``___�dE ___._r_________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Ilf yes,date-_---- ---------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic a 'k: Distance from nearest well-----------------Distance from foundation--------------------Material--------------------------------------__________. No. of compartments------- -- - --�---Size--------------------------------Liquid depth--------------------------Capacity--------------------- osal yep Distance from nearest welLt_0 _:_.__Distance from foundation-_•_A j A&" to nearest lot li e____ .-- �` Number of lines_________ 1.___ --Length of each line_ _tr---------------.Width of french._ �.____.____�_.-- 1 _,,4 }''v d Type of filter material___. _..._ •t, Depth of.filter material-- --�f- - Total length-----------------_____&c:(J___.___-_ ; p � P S�aI Distance to nearest well--I �`�_. ______Distance from foundation__� .___.Dist nce to nearest lot line-____ _____. `1 � Number of pits----- -------_-------Lining material__Ic_c' ________Size: Diameter______' x----____Depth____Z_,,V___________---- i a 7C esspool: �~ Distance from nearest well-----------------Distano fro foundation--------------------Lining material---__-------------------------------- El ______--_-- -----______________❑ Size: Diameter--------------------------------------Dep+h-------- -------------- --------- -- -----.Liquid Capacity---------•-----------------gals. Privy: Distance from nearest well---------------_----------------------------------Distance from nearest building________________________________--____-_. i ❑ Distance to nearest lot lire--------r---------------------------------- '---=-------------------------------------------------------------------------------------- -- --------- Remodeling and/or repairing (describe)--------- ---------------------_-----____-- ___-- a--------------------..._-- _ _ 7 --•------------•----------------------•--- -- ------- -------------------------••---- r " r ----------------------------- ------ ---------------------------------------------------•-.----- - ----------- ---- ------------------- ; I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. DAY R, NIGHT ' (Signed----____ S:r tit_3swServi nk-----------ce ---( rid/or Contractor) HO By:------ ------------------Stockton -�t:M-- --------------------------------= {Title)------------------- -------- (Plot plan, showing size of lot, location of-system in relation to wells, b tidings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___-_ l /,-,t- ----------- ---- ------- --- "�...1�---------------------------- --------- DATE------1----_-----'�r--------�l�l.--- -----�� - REVIEWEDBY----------------------------------------- ---- - ----- - --------. -------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------ --- -------. DATE----- -------•----------------------------------z---------- Alterations and/or recommendationsd -/ �fr '��--_--"z`��c G= _ �t 'M.---- -- ------ C____ -----------I----------------- ___-_____________.__________._____________-_-._________________-__"_.________._________-__________ FINAL INSPECTION BY:----- .Ae--- h --- Date- L ...... ._._/. . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ' 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E6 9 REVISED S-B9 3M 3•'63 F.P.EO. '�F