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rUK UH-ICE USE: --------- / s --��It_7�-------------.------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. Z�2__(0- 9 (Complete in Duplicate) ----- This Permif Ex fires ] Year From Date Issued Date issued...___'h�0-3 , 1 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 Ordinance No. 549. F ,y-- p _ s � l JOB ADDRESS AND LOCATION--------4J-_.Z__v?_t3_------- -- I.f� J. 11/-------------- `---'------------- a F Owner's Name-------------- F. _.. -'-'---------------- -' ' --'------------ --' ----------- -- Pone-----•--•---------_----------------- Address----------4101 ' -- ------------•---------------------------------••--------- 4 s ------------- Contractor's Name------ -". �_�i r . -----_4- -------- -------- - ----- --- --------- - - -'=-- ---------------- Phone -------------•--••--------• 4 Installation will serve: 'Residence �Ap`drtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living.units: _— Numb of bedrooms _,' __ Numberkof.baths Water Supply: Public system ❑ Community system ❑ 1#rivafe a__,5epth to'Water Table 611415,1t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam3❑ Clay Loa ❑ Clay ❑ Adobe Hardpan ❑ i' Previous Application Made: (If yes,date._-I-----------____) No ®'' New Construction: Yes VrNo [7] FHA/VA: Yes P-- No ElCIF TYPE OF INSTALLATION AND SPEICATIONS: (No septic tank or cesspool permitted if public sewer is available within 100 feet.) No. of tom artments_. - $ize F t , s i ------------- p - - undaJion__:-.G�- ---._.Mat �i--- t Se Tank: Distance compartments-AA nearest we�l_--��-:-pist n:_ #fX flame Liquididepth__._ _-�______---_. Disposal Field: Distance from neares welt--47,9----Distance from founda�tyion--_ ___ -__f Distance to nearest lot line___' " Number of lines_____=__ _ -...___-Length of each line_!c-_ L .- `� .Width of #Tench. • �; Type of filter.material_ 7 Depth of filter,material_,,f --___ ._Total length__Z.0_ _;-------------- i i 1 Seepage Pit: Distance #o nearest well ___��_-__Dist nce from foundation___xQ =___�Distancce to nearest lot lie._ __7 y Number of pitss------------___Lining mater.iAl_�Q4,f��_.Size: Diameter-_. - Dept Cesspool: Distance from nearest well-----------------Distance from'fou dation.__._.____.____.__-.Lining material-------------------------------------- ❑ Size: Diameter-------- p= ---------------------------- ----------De th _.:: ---- ------------. t----Li - - - quid�CapacitY--'----'------ ------------9al�s� Privy: -pistance.from—nearest well--:,,.., �--�.;__-� �„Distance froi :nearest,built]ing------------------------------------ ❑ Distance to nearest lot line---------- i� ..... 1-f----' -..Remodeling and/or repairing (describe):----------- e 55/ ----- - � t ---------• ----••---------•---------------------•- •----•---•-------------------------------------------•---------------------------------------------------------------------------::_------- ----------------------- . I --------------------------------------------------------•---------------------------------------------------------•------------------•----•----•------•--F--------------'---ii--------•------•---- . -----------------------------•----{--------------------------------------•--------------------_---------------------=-----•-----------------------.----`-------- --------- ----------------------------------------'------ I herebycertif l that I have yf 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 Joaquin Local Health District. � _ ---------( �/or Contractor) By:----------------------------------------------------------- ----------------- F Title._. --------- -- -( } 4-fJ.�lt'------------ - (Plot plan, showing size of lot, location of system.in rel on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY----------- . REVIEWED BY ' ---- = - DATE - / ----11--f- ---- --'---------- -- ----------- -- J' ---------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------- ------------------------------------------ ATE Alterations and/or recommendations:------------- „�L-t-��'--.,,�� -" •G_'�-��.,-� �YL---- -` --------- ------------------ ---------------------- Jfo - t _ ^a ` _...__ �Tti if(' , -.__.... ------ L -� ----•-- ------ �- ----------- ---------- ------------- - ------ -----------•----------- ---------------------------------------- FINAL INSPECTION7-1 BY:. -------- -------------- ....... ------- Date----- SAN JOAQU;IN LOCAL HEALTH DISTRICT ,+ 1601 E.Hazellon Ave. 300 West dqk Street, ^t i '� 124 Sycamore Street �-. 26!i West 91h Street Stockton,California Lodi,California Manteca,California Trticy,California ES 9 REVISED B-59 3M 3-'63 F.P.Gp. ii