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FOR OFFICE USE: ----------------------------- --------------------------- ------------------------------ - ------------------------ APPLICATION FOR SANITATION PERMIT Permit No. f.........___...______ --------- --------------- ------------- (Complete in Duplicate) -.-.--- This Permit Expires 1 Year From Date Issued 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 comp iance with County Ordinance No. 549. FSCA LO Aj JOB ADDRESS AND LOCA ZOIN .5-e-44 AV, �� '" /S�drj'7- _0 1 '/ f ......................... ---- ----- . Owner's Name------- -------- - ---� Address-----------------) --./-------- Q �/j RC1----- _C'.P�/Q/1t-------0_4-//f� --- --------------------------------------------- Contractor's Name------ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms A--- Number of aths _J-___ Lot size _--I� 'Q ---------______________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [4 Clay ❑ Adobe ❑ Hardpanffl- Previous Application Made: [If yes,date-------------___----l No E4 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:) Septic Tank: Distance from neaFesf-well___Lr-,O____Distance from foundation___sS-----_------Material------171 No. of compartments...... _Size---------------------------------Liquid depth--------------------------Capacity---f�2_0_d---- %I Disposal Field: Distance from nearest we11___!5.-0--._Distance from foundation__-.� .______pistance to nearest lot ane---;.-Q-� ❑ Number of lines___._________---------------Length of each Iine.7X___-A;t_�3_.Width of trench----- v r-------------- Type of filter material---P-6-c-k-----Depth of filter material____.1_1-_________.Total length--------91d_:______________________ Seepage Pit: Distance to nearest well----/__r20_`-------Distance from foundation---- --------Di tanceto nearest lot line__.:______.___: El Number of pits-------1------------Lining material---P�J_C-e._.-__Size: Diameter___51. 4'_P_ _--Dept h_._.__/ Cesspool: Distance from nearest well--------------_Distance from foundation----------------.---Lining material------------------------------------- El Size: Diameter------`--------------------- ----------Depth----------------------------------------------------Liquid 'Capacity----------------------------gals. Privy: Distance from nearest weli-----___-----------------------------------------Distance from nearest building---------------------______________.__... ❑ Distance to nearest lot line-------------=--------------------------------------------------•-------------- ------------------------------------ I Remodeling and/or repairing (describe):---------------------- ---- -•-------------- -------------------------------------------------------- -----------.Vefc'----------sfi''�/-G__�O.,ite......_17_V_47�'..< lel ------------------------------------ -- --------------•------------------------------------------------------------------•--------------------- --------------- ------------------------------ - ------------- AN4 - - f� _ 1 -------C-F 4 �N �- ----- [&F------- � ��. I hereby certify that I have prepared this application and that the work will be done in accordafice with San Joaquin County ordinances, State laws,-and rules and regulations of the San Joaquin Local Health District. F-:FO)Z,F—_ F1 19 C-- (Signed)-----_- ----- ------------------(Owner and/or Contractor) --- -- ---- -------- - (Title]_ xJ.[7:C_ 7 - r_ (Plot plan, showing size of lot ation of system in relation to wells, buildings, etc., can be placed on reverse side). *-� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ['t =V� ------------------------------------------------------------------- DATE----- r REVIEWEDBY------ -------------------------------------- -------------- ------ DATE----- -- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------ Alterations and/or recommendations:------------------------- ---------------------------------------------- --------------------------- ----------- -------------- ------------------------------------------------------------------------ -------•-------------• ------------------------ ------------------------__--------------------------------------------- ----------.--------------------------------------•---------------------------------------------I----------------------------•----------------------------------------------------------------------•- ------------------------------------------- -----•--------------- -------------------•--•---------------- -------- --------------- -------------------------------------------------------- I---------------------------------------------------------------- 4 ------ - -- - ---- -- ----------------------------------•------------------------------------------------- ------------------------------------ FINAL INSPECTlO - ---------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street , Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S'S9 3M 3-'63 F.P.DD.