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FOR FFICE USE: ---�12 2/---i�.L _ ___________ ------ _ APPLICATION FOR SANITATION:PIERMIT �y Permit No. .,� ._ .!__ �` S'/ -- - --. (Complete.in,Duplicate) � m � �'� -'Date Issued --------- ------------------------- -------------------- This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a_�ermit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------I _ _f`Y.____, s� Y _ `-: •-----------------------•-----•--------------------------------- I / 's Name------��V-. _*ala f'SF�S Ci .i Phone Owner --------------- Address-----------------' .. .�_a1 3�.n � f i Contractor's Name___________________________ __r A.-v. _�------------------- ------ -------------------..----- Phone--- Z�6 ------- Installation will serve: Residence E Apartment House ❑ Commercial ❑ Trailer Court ❑ Motelt❑ Other ❑ fNumber of living units:../_-_- Number.of bedrooms .,4----.,Numbernof baths Lotisize ----4Q_ _x-Qpe,__ I ------------------------- I ; � Water Supply: Public system E] Community system E Private ❑ Depth to Water Table 'Sof Character of soil to a depth of 3 feet: Sand [I Gravel [I Sandy Loam El Clay Loam ❑ Clay ❑ TAdobe Hardpan E] Previous Application Made: (If yes,date.-.__.--r_.,--------) No [j4 New Construction: Yes No [] FHA/VA: Yes ❑ No ®-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tankfor cesspool permitted if•.pulalic sewer is available within 200 feet.)' Septic Tank: Ditante from nearest welll- -------Distance from foundation-----1_iz------- [ Material-_. thN# of compartments-------- --------------- Sf-----_Li Liquid de . -----`l --- - /-Q _CavpYac_5ilt_y1 l LN Disposal Field: Distance from nearest wel ,7:_ l-. 0-___.-_Distance from foundation__f.�------____.Distance to nearest lot line_.._-` -.___.. Number of lines----------- ----------------------Length of each line------- ---------•-------------Width of french------Z-E Type of filter materials±� --_-Depth of filter material-_-! '_"____ ---.-Total length__-_----_`�-�''-'-.�--------_ - Seepage Pit: Distance to nearest well__'o ---------Distance from foundation---�°_--.1--..-.Distance to nearest lot line_-�--__-.-___ s [fr Nufmber of pits.-------1--_--- ---Lining material---1 oc_k----size: Diameter_._3 .if--------.Depth----�-;y__--•------------ -- Cesspool: Distance from nearest well-----------------Distance from foundation-----_--_____-1__...Lining material-...-__.-----------__-__-----_--__-_ ❑ 1z -------------------------- ----------Depth-------------- --!--------------------------- ...Liquid Capacity----------------------------gals. { Privy: Distance from nearest we ------------- -------------------_-------1_ stance r/ nearest bJdig � un _ ❑ z DifA Distance to nearest lot line } Remodeling and/or repairing (describe)------- -------------- ----------------- ----------------------- 9.. : . {.. ---------------•----------------------•---- --------------------------- - ! s ! ________------------------------------------------------------------------------------- ------------------ ------------------------------------------- ------------------------------------------------------------------------------------- I 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 reulatio�f the San Joaquin Local Health District. r ---- ,'------ (Signed) (Owner and/or'Contractor) ' -------- .._y - . r By:----------- / -- -- ---------,1••. ---- -- - --- -- - ---------------------------- ----------------------(Title)- ------------------------------------- ------------'- - -------- -------------- - - ------ - --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). .t FOR DEPARTMENT USE ONLY AI'I'LICATION ACCEPTED BY - - - -- `--��--- DATE -------= ---------- REVIEWED BY-------------------------------------- - / / 4 - --------- DATE------------- ------ BUILDING PERMIT ISSUED -------------------------------------- DATE------- --------------- Alterations and/or recommendations:__-------_._.-._. ---•------ -------•--------------------------------•----•-------------- ------------------•-----------------•-------- ---•------------------------------------- ------------------------------------------------------- ---------- -------------------------------•--------------------•---------------- - t , FINAL INSPECTION BY-------- ----------------- ----- ------- --------- Date--------- 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,California Tracy,California ES 9 REVISED 8-S9 3M 3-'63 F.F.CD.