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FOR C*FICE USff �_- _)_: I--------- ------------ ------''-----------I,`_ ,�_�__-_ APPLICATION FOR SANITATION PERMIT Permit No. __.l- --To-- --- (Complete in Duplicate) --- " - - This permit Expires 1 Year From Date Issued Date Issued __-1,61141 Application is hereby made to the San Joaquin Loca! Health District for a permit t construct and install the work herein/described. This application is made in complian e w' t r `� I nc o. 44. �/ -"--- JOB ADDRESS AND LOCATIO _ Q-t---___ � !; ------Owner's Name__"_. _. _'- _ - -----------•-------------------------------------------------:---------------.. Phone----------- ------------------- ------._._._ L C� C -------- ••--------------•----•--- ---- Confiractor's Name----- ' Installation wi!! serve: Residence --------------------------------------------- Phone.........•------------------------ . [ Aperfinent House ❑ ' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number o{ living units: ---I--- Number of bedrooms --3--- Number of baths I------ Lot size _12.2-,X-/-/ Water Supply';: Public system �-------------------------------- Y M—Community system ❑ Private ❑ Depth to Water Table i - ft. Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hard ®� pan ❑ Previous Appli11 cation Made: (If yes,date-------------_-----I No Z]—" New Construction: Yes [A-No ❑ FHA/VA; Yes ❑ No TYPE OF INS ALLATION AND SPECIFICATIONS: ,�(No septic tank or cesspool permitted if public sewer is available within 200 feet.) -Sep�tic_Tank: II� Distance from nearest well from foundation--/-*.---." - Material--- No. of compartments_ 3 - 2- --e-�-'-�- ---t-r----�-i--t---r"--c-"�O-l-= ---- -----.. --�---- ------------Size--- Liquid depth- � CitYDisposal Field: apac Distance nearest well----- ------ �� Distance from foundation__ -----------Distance to nearest lot line-57. Number I Number of lines___.: i Length of each line 7� -.Width of trench-----A r Type of filter material_-` Depth of filter material--- ---------Total length---- --- Seepage Pit: Distance to nearest well----.---_--_------Distance from foundation Disfiance to nearest lot line__,- -- ---• V1 Number of pits__ -------------------- _--- Lining material__''_I�o _ .. ' Size: Diameter-_ _ Depth - --------------------- Distance Cesspool: from nearest well ------------ from•foundation_-___-___N_- - :Lining material_________________ ❑ Size: Diameter--------- - It, ------------ ----•- Depth -------- _ e� Priv --- Li quid Capacity------------------------'--gals. Y= Distance,from nearest well------------------ ------ -_ Distance from nearest b0din 0 �I Distance to nearest lot line g------------------------------- I " """ � ----------- I -- -- Remodeiing and/or repairing (describe)_------------------ ---------------------------------_ J ii ---------------------------- - ----------- --------------------------------------------------------------- -------------------------- ------ !, - 1 l -`--•-------- ----------- --- ----------•---------------------------------- ' --------- --------------------------------------------------------------------------•--------------- I hereby certify that I have prepared this application and that the work will be done in accordancelwifh San Joaquin County ll ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- 1- C t gy---------J-- •--------- -�--------• ------------------------------------------------------------ ------- ------------------- --------- ^---'--- --"-rile_-------------------- — (OWAeA-erra$Wbr Contras •- ----- - ---------------------------- ----- -----I )------ --- --- -- (Plot plan, showing size of lot. location of system in relation to wells, buildings, etc., can be placed 'on_ reverse side). !� FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY______________ -LC/ •• p ' DATE--------1" REVIEWED BY �i - - ---------------- ---------------------------- - DATE------ ----------------------------------------------------- ----------------- BUILDING PERMIT ISSUEQ-----------------�-------------------f-- �-----"---" --- II _. ------------------------------------------- '------- DATE-------------------------- --------.......... Altera��on nd/br recommenions:_ ______________ ___ � `` . 1 .. ---------- == ------ _._��______________________ / y -_____._____________.___________._-."_-___.-___________.________-_-____-___----------------- -------------------------._____---.II___________________--V4�JL�►'LJ�-ry..--- .y _______-."__.________ _____.______/___ °.,__________.____.___.----y______--------------------------------------------------- ---------- I 4 - ______ - v - _ i ` e2_-r----------- ---------------- ------------------ FINAL INSPECTION B, : / _- --------------------------------- Date ------------------------- ---------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton'll California Lodi,California Manteca, California ;I Tracy,California CS 9 REVISED 9-s9 3M 3-'63 F.P.CO.