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FOR OFFICE USE: - N 7.-A_>_-(,_I-------------- :_.3-s�.. Permit No. 7 APPLICATION FOR SANITATION PERMIT f _ _ _ (Complete in Duplicate) Date issued :_7L___7_ _rP -------- ----- ------ ----------- ._._ -_._---_ iThis Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to co struct and install the work herein described. This application is made in compliance with County-Ordinance No. 549. ,~I�rS fi 105E: 611 "jVEJ ``�� Al,------,o �r►i ------------------------------------ % .�/ JOB ADDRESS AND LOCATION____"7c3T_7______ _ -------- Q Owner's Name = --- -------:-------- Phone._T:7 r7 Address------ -------------------------------------------------------------- / . -ter -.;��.I'►:�`�.�-�----=--:.�_ _+_4 •----------------------------------- ------•---- --------------------- ----- Phone- 6 - - ..0I -p- Contractor`s Name------ Other Installation will serve:'"Residence� Apartment House El Commercial [:] Trailer Court ❑ Motel C] [_1 Lot size ______ €' +-Number of living. units: ___1___ Number of bedrooms T-_ Number of baths _ ' - Y = Water Supply: Public,system ❑I Community system ❑ Private to Water Tabled_ ft. )<��ep;h �, Character of soil to a depth of 3-feet: Sand E] Gravel E] Sandy Loam ElClay Loam ElClay ❑ Adobe Hardpan F1 k Previous Application Made: (If yes,date----------- -------) Noo New Construction: Yes❑ "'NoX FHA/VA: Yes E] Nor I TYPE 'OF INSTALLATION AND rSPECIFICATIONS: � (No septic tank`or,cesspool permitted"if public sewer is available within 200 feet.)-- Septic .Tank: Distance from nearest well-----------------Distance from foundation------------------_,Material-------- ------------------_------------.------ 1 ❑ No. of compartments--------------------------Size---------------------------------Liquid depth---------------- ------ 1CapacitY------------------ Disposal Field: Distance from nearest well--„ .......Distance from foundation-_3_Q-'.__.__Distance to nearest lot line__?`_.. 5'flA Number of lines____________f___-- -------------Length of each line------- ----------Width of french_._.______-- ------ ---- E-2(f.�• ! '� __-Total len /�t7 IA TYPe.of filter material--_ PC.�---Depth of filter material ----- gth- _ Di . J Seepage Pit: Distance to nearest;well___________-______--_Distance from foundation_ Distancerto!nearest lot line_____________... ❑ Number of pits------------- ----Lining material---_ ------ - -----Size-Diameter-------- --iDeptn--------------------------------- W CesspooL` Distance __--Distance from foundation �______________w- Lining material____._._____._____ __________ -._____ ❑ Size: Diameter°----------- -- ----- --------Depth---- ------. -------- -------- --------Liquid Capacity- ---------- --- gals. Privy: Distance from nearest well,-_--------I--------------------------------Distance from nearest building.___--____ ❑. Distance-,to nearest lot,fine---------------- -------------------------------------------------- --- I F * SFX{•STl. �'� rt - Remodeling and/or repairing (describe):--.- .1-W - -- - -- - - € - ---------------------•--•------------------------------------------------------------------------------- '1 j-t----.----- I---------------- -- ,-- �. ----------------•-- --------------------------------------------------------------- -------- - - --- - - --------= -------------• - t ------ I hereby certify that I have prepared ibis application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San JoaquiniLocal Health District. . Q - ---------------------------------------------- (Signed) (O n$rFand/or Contractor - lG �ri ti -- BY�v 4' '` rte _'' �- - Title -- -------=------------ ( ) (Plot plan, showing size of lot, locali _ of system in relation to wells,,buildings„etc.,-can be..placed4on reverse side).,._.., i FOR DEPARTMENT USE ONLY ATE 72 APPLICATION ACCEPTED BY_.._.L_ ------sf! -------------- ---------------------------------- DATE___', ---A --------------------------------- REVIEWEDBY----------------------------------•---------- ------------ ---AI` ------------ ` BUILDING PERMIT ISSUED-------------- ----------- ------ DATE. Alterations and/or recommendations--------------- -------- ----- --------- ------------------------------------------------------------------------ ► NI --------------- --•--- --•------------------------------- ------------------------------------------------------------- t -----------------------------•----•------------------ - ----------------------------------------- •-------•------ -------------------------- r `f FINAL INSPECTION BY:-----�1 � Date..... f 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hastlton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California �B 9 REVISED B-59 3M 3-63 F.P.CO.