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FOR OFFICE USE: ----------------- -------- `� APPLICATION FOR SANITATIOf+ PERMIT Permit No. .__P 3------- -------------------------"-----------4--•'- ------------ - ----------------- - ------------------------------ -- ------------ ---------- (Complete in Duplicate) _ Date Issued _____ '.--------- - --- 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 war herein escn d. � This application is de in:cryom�plianc "wrth-County-Ordinance No. 549. Ile ---------------- - lig JOB ADDRESS AND LOCATION' Owner's Name------------ ------- f�----�- �--------------------- ---:--------------- ------ hone-__4P; 57-ez Phone-4_ ------,•- �' �' Address-----•------•--------------"� - •- �-•---.��l�_� �'�---------- --------- --� �------------=-----.:.----•--------• - Contractor's Name--------------•---/�1-��--_�-_�.��f�- ---�---'-�'�� ---------- --------------- - -- ----------------•-----------._._ Phoned� .� ----- i ❑ Moel ❑ OtherInstallation will serve: Residence �fA artment House E] Commercial ❑ Trailer Court ❑ r Number of living units: {. Number of bedrooms _A- Number of baths __ Lot size --- ------------------ Water 5tipply: Public system ❑ Community system ❑ Private 015.epth to Water'Table 6e ft.- . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No B--FHA/VA: Yes ❑ No E�—� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F„ Septic Tank: Distance from nearest wel{._.__--........Distance from foundation-----------:-------.Material......................._ ..........._____-.._.-. ❑ No. of compartments-------------------.- - --- Liquid depth--------------------------Capacity-----------------------�i� ` o Disposal,_Field: Distance from nearest well__-- ..-- D,stance from founda)tio /.�--....__.Distance to nearest lot line--�'A ._. }X _ Length of each line--- -----_- Width of trench.-2.gd--"-------------- -� Number of lines....-_.._f...... -_ g �� - -- sv -- Type or filter material__ -,rp��-Depth of filterimaterial---/e ------Total length.-.-.-.��1.9...... See pag it: Distance to nearest well IeV_ ------Distance fro foundation_-_._............. �� �1�-" Distance to nearest lot line..-.� � Number of its----------.-/-.._____-Linin material__ /_e1&e - ...Size Diameter____-�.1..._-___Depth.__. '=:.- ._ I p 9 i-_ : I ; Cesspool: Distance from nearest well---------------_Distance from foundation.____._.....______..Lining material: -_ ..,..-.r .-_2_____-.__. I ❑ ----.Size-: Diameter--- ::_ = Depth ». -7, ---- `= -� l LiquideCapacity gals. �1 Priv Distance from nearest well---- ------ ------------ - - 'Distance from nearest building_____ ..-------- ._. y: Distanceto nearest lot line------------- --- -------------------------- ---I----- ------------------------------------------------------ --------- ;. Re'modeli g and/or repairing (describe}:-------1T r 7 'cam � i � -------------------- --------- ------------•---------------------------------------- :• t .r -------------- -------- ---- --------------------------------------- : :... r -------------------------------- - ------------ ----- ------------------- 1-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 JoaquinkL caealth District. / � / wine nd or Contractor (Signed)----------------------- - x ` e_i< } `. I By ••--------------- ... -------(Title} 1 (Plot plan;-showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT'USE ONLY APPLICATIONACCEPTED BY--._ .Ls.Y +x ►-------------------------- ---------------------------------------- DATE-------- - ------ --- --'�---------------------- REVIEWEDBY-------=-----=------------ ------------------------ ------- - -------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------ --------------------------- ------- --------------- --------- DATE---------------------------------------------- ---------- Alterationsand/or recommend ations:--------- ------------------ -----------------------------•---------------------------------------------- ----------------------------- -------------------- iTl1' .--------` --- �9US US 'fN 0_1 1 .U .1 t -� -r `01--------------------------------------------------------- _ -- k ------ ---------------------------- -- --< ----------------- ----- ------------•-- -- --- ..... .------------------------ ------------- ------- -------------- ---------------- ---------------- FINAL INSPECTI ------ --- - --- - - Date--- --------3_-'L�.---[2(Q_----------------------------------- SAN ------------------------ - •----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,CaliforniaTracy,California } F.P.0 O. '