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FOR OFFICE USE: ---------------------/0- / ------------------------------------ ----- -- ,, APPLICATION FOR SANITATFON PERMIT Permit No. _41-_ _--- -- -- - ---- - --------------------- --------------- (Comple+e•in Duplicafe) ---.--. 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__! �----%5;----- -----------------------------------------•-------------------------------------------- ,�,� j Owner's Name----------- �_ 0,4_e - Phone.. of Address..-------Zefe..,•.�-j-......51S51_ (,� r. Contractor's Name__!k- 'f 1.R'0 ---------------- - --------- Phone---•- ----------------- Installation will serve: Residence 'Apartment House E] Commercial ❑ Trailer_Court .❑ Motel ❑. .Other. ❑ Number of living units-./---- Number of bedrooms --- Number of baths_fLot size � �_[Sf_ _ ------------------_______ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 4Q ft Character of soil to a depth of 3 feet' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ! Previous Application Made: Iif yes,date_- ....... ] No g;�' New Construction:•Yes ❑ No W�— FHA/VA: Yes ❑ No Z�.— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ffan):j, Distance from nearest well-----------------Distance from foundation-------------------Material --------------------------------------...._----. "19tf No. of compartments------- ---- ------------Size--------------------- -------•---Liquid depth--------- ------- -------Capacity----------------------- Disposai Field: Distance from nearest well-----------------Distance from foundation---_:--------------Distance to nearest lot line--------.-------- &'Vf . '�- 6'j Number of lines---------------------------- ---Length of each line--.--------------.------------ i f of trench_:_._-__-._-----__-_..-_--:_-__---- Type of filter material-------------------------Depth of filter material-----------------------Total Seepage Pit: Distance to nearest well-----.�--l�--_--.Distance from foundation-ZA9---------Distance to nearest lot linne__a.�- ----- A--' Number of pits--- .?----------_Lining material.--, `/ Size: Diameter-,�.'. _ -------Depff_9?57-------------__--.-- Cesspool: Distance from nearest well ----------------Distance from foundation..... ........... . Lining material-_------------ ----------------------- ❑ Size: Diameter- ---- -- ---- ----- ----------------Depth------------ --------------------- -------------..Liquid Capacity------- --------------._--gals. Privy: Distance from nearest well------------------ ------------------------------Distance from nearest building---._-.--__-.-.__------.____-._-..------. ❑ Distance to nearest lot line --------------`-------------_-:' - - Remode•ng and/or repairing (describe):............. trJ---=.,�-- f ►-- t --�-�- - � -�-- -�-- .-.-'�.fd.��'�._ �.,�_/.tom--•-'-�� .---- I ---------- --------------- ----- ------ ' �` 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 regulations of the SAn Joaquin Local Health District. (Signed)------------------ ' r ----_(C1.�or Contractor) By------------------------------- --------- -------- -------------(Title)-- 6x 'X� 4.,.------------ (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` . APPLICATION ACCEPTED JBY-------------- - - ; DATE �� REVIEWEDBY------------- ------------------ -- ---------------------------== =E- ---- DATE---------------- BUILDING PERMIT ISSUED---------- - ----------- ------------------------------------------------------- --- ----------.-. DATE---- ----- ------------ --------------------- ` Alterations and/or recommendations:--------- . ------------------- --------------------------•-------------------------------------------- -------------- --------------------- -•----------------------------------------------------- --------------- --------- ------ --------=-------...----------- - - - -------------------------------- ---------------•---- •------------------ ----------------------------•-------------------------- --------------- ----------------------------------------- ------------------------------------------ --------- ------ { f, , FINAL INSPECTION BY --- -- �'�f_�{.E'�r' Date � -:`� ------------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street SLodi, California tockton,California Manteca,California Tracy,California �j`ygr E.H.9 2M 1.67-Variguard Press