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/ V i. -- ................__ Af -CATION FOR SANITATION PERI' Permit No. ___ 111d_�L.L__ ----------------------------------------- ---------- (Complete in Duplicafa) S( Date Issued ----------------------------------------------- ...... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Pistrict for a permit to construct and install the work herein descrbed. This application is made in co lithiC�opntyI�ls} 4i9ce ' JOB ADDRESS AND�LOCATION_ -=-? _yN-- --- r�1^ 3 - -_--•--- -- �+`.c------------------ Owner's Name-----��_ c. .-------- r =1& "---------.. . --------------------------------------------•---------------- Phone----------------------------------- Address---------------------- ise - --------------------�-%-------------------------------------------------- ----------------_------------- Contractor's Name------f112-4: --------------------------- ------------------ Phone--------------------------------- Installation will serve: Residence f8 Apartment House ❑ Commercial ❑ Trailer Court—El M6fe1`0- r ❑ Number of living units: I..... Number of bedrooms_:_3--- Number of baths _ .__ Lo size -------- _________•___________ Water Supply: Public system ❑ Corti.mun"ity system ❑ Private I ) Depth to Water Ta ___ ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam-M Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes date....................) No ® New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ C�V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perm'itted'if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well�_riTb t Distancefrom f ndation__..._�®_f_.__.Material ------------------------------------------- No. ----_-�---- -------•------- No. of compartments______-- -------------Size__'`°'_k^"`_C�__"---.-_:___Liquid depth___._-__-_____-______Capacity__/_I_ ____-__ Disposal Field: Distance from nearest well AA 1_..._.Distance from foundation__ _l........ to nearest lot line__~¢___.__. Number of lines___ .Y :___. :_ __. .._.__Length of eaclii`line1,�-.q_t_4_ __ J =!"1 idth of trench__:�Y: , . _-- O Type of filter matenaI\kt._kL_,-_ti_ ---Depth of filter material-___.)1--------------Total length_:_1.6_Q_____ _________________ _____ 0 Seepage Pit: Distance to nearest well----------------------Distance from fqundation-------------------Distanpe to n-ear6s_t lot line-___-____.-______ s ❑ Number of pits----------------------Lining material--------------L_,_,.__Size: Diameter-------:_-_--------------Depth_..__-___-__.____-______-.__..... 'S Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.-__. ------------- . ______-_ _ _1D_ El Size: Diameter------------------------------ ----Depth-------------------------------------------.-----Liquid Capacity------------------- .jai;,�,Q Privy: Distance from nearest well_____----__----------___----------------------Distance from nearest building------ -.___.______.. ._.._- ❑ Distance to nearest lot line--------- --- ----------------------------------------------------- ------------------------•-------------------------- -- - Remodeling and/or repairing (describe):_-- ---- -__-_..___._ . s' ------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------•-----------------------------------------------•----------------------------------------------- hereby ce i _that._I_have prepared this application and that the work will be done in accordance with San Joaquin County ordinanees;-Su I'ws, and rules egulations of the Sano quin Local Health District. I :(Signed)-- ---- -- ----- --------- - - -- ---- ---------------- - ------------ ----- - (Owner and/or Contractor) By:------- ----------------------------------- ---- ------------------------ ----------------------------------- --------------(Title)------------------------------- - (Plat_plan, showing size of lot, location of sysfe ' a ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -= APPLICATION ACCEPTED BY.-. ----- Al ------------------------------------------------------- DA E__(- .-k ----------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DAIS _=== BUILDING PERMIT ISSUED------------------------------------- ------------ - ------------------------------------------ DATE------------•----------------•------ ----------------------- Alterations and/or recommendations:--------_--------------------------------------------------------------------------------------------------------------------------•---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----•---•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------• ----------------------------------------------------------------------------------------------------------------------------------•---•----------- FINAL INSPECTION - �f ------- Date_ .._�..J_'- -- -------------•--•-- BY:-- ,�'� :�:,,:..� �-�`-�------------ f ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak S:,eet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVIFED 8-59 3M 3-'63 F.P.CO.