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FOR OFFICE USE: <br /> ,' APPLICATION FQ�.SANITATION PERMIT Permit No. <br /> � � -- - <br /> ----------------- ------------.------ --------------------- (Complie In Duplicate) �O ,� <br /> Date issued�________________ <br /> -------------- --------------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 544: <br /> JOB ADDRESS AN^D-LOCATION----��-�.V � .- G�'1� ?f�----- � f-------------------------------------------------------------- r,l <br /> Owner's Name--------J-Ipj)-,v---------5/AbfvV....----...... •---------------•-------------------------------------------- -------------------- Phone------------------------------------ <br /> Address1!6 1. ` s! 7-je --------------------------------------------------------------------------------­------------------ -------------- <br /> Phonelt' _6Q'. <br /> Contractors Name----. -L11.-..,1.11 --- --- ------------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -- f__ Number of bedrooms ___'2:�-.Number of baths ---(--- Lot size -----5:3? ------X-1,,-Q------------------------ <br /> i <br /> Water Supply: Public system ,{ Community'-system-E] Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,dote--------------------1 NoNew Construction: Yes ❑ NoX FHA/VA: Yes ❑ No JX <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank.or cesspool permitted if public sewer is available within 200 feet') <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------_-_--------Material --------------.--.---------------------- <br /> ❑ No. of compartments--------------------------size--------------------------------Ligwd'depth-------------------------.Capacity...-------------------- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation---------------------Distance to nearest lot line------__.---..... <br /> ❑ Number of lines-----------------------------------Length of each line-----------------------_- _---Width of trench.-----------.--------------------- <br /> Type of filter material-------------------------Depth of filter material------------------------- otal length------------------------------------------- <br /> Seepage Pit: Distance to nearest well___A)0A­9 ----Distance from foundation---_2.!' to nearest lot line------------ <br /> Number of pits---------l-----------Lining material--F--re-44.--..Size: Diameter-------- Depth <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------- .Lining material--.--------.-------------------------. <br /> ❑ Size: Diameter---- ---- ------------------ ---------Depth------------------------------------ - --------->-.-Liquid Capacity- -------------------.------gals. <br /> Privy: Distance from nearest well ---_----------------------"-------------------Distance from nearest building----------------------------_----.----.-. <br /> ❑ Distance to nearest lot line-------------------------- -- --- <br /> Remodeling and/or repairing (describe):------- 'd-------M—--------e)(1-b-%L!4-1-_q-------- --------------- <br /> -r <br /> -------------------------•------------------------------------------------------------------------------------------------------------------------•----------------------------------------------- <br /> -----------------f <br /> I hereby certify that I have prepared this application and'that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------sC:1=�{ = L-- -�1�' ` -'----- -------------------------- (Owner and/or Contractor) <br /> By;-------- . �• ------Z l� = --------------------------------- <br /> (Plot <br /> ---------------- (Title) ..- - <br /> Plot Ian, showing size of lot, locatio of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> L P r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ,-- - -------------- ------------------------i----------- DATE----- -! y --- <br /> REVIEWEDBY------------------------------ ----- ------ ---------------------------- ----------------------- 1----------. .... DATE------------ -------•-•-------------•-------------- ------- <br /> BUILDING PERMIT ISSUED `-- ----------------------------------------------------------------�------ DATE <br /> Alterations and/or; commendations- ` s <br /> . •---- <br /> ,� ---��----`----------- z `---- -- --- -- ------� �;-`-------- , %� -----------•------------------- <br /> ------------------------------------ ------------------------------------------------------------------------------------ -------------- ------------- ------------------------------------------------------------- <br /> , ; <br /> ------------------------------------------ ---------------- ---------- - -------------------------------------------------------------- ------ •----------------------------------- ------------------------ <br /> ----------------------------------- ----- ------------- ------------------_ -- - --------------------------------------- - ------------------------------ -------------- . ------ - ----------------------------- <br /> t <br /> Date - -��-r 3 ----------------------- <br /> FINAL INSPECTION BY: 1 — �-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California a <br /> ES 9 REVISED 8-59 3M 3-'63 F.P.CD. <br /> d <br />