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FQR OFFICE USE`-_-4-- ----------------7r? ---44G ---------_-.--.- APPLICATION POR SANITATION PERMIT Permit No. __ __________________ -# .__.. � ;` __..: _ [Complete in Duplicate) 7 (f ------------------------------------ --------'----------- _ e Issued Date Issued ".... ..-.---•__/ _ is Permit Expires 1 Year from Dat t Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein deserted. This application is made in compliance withrCoun,ty_O.rdinance_No.-549... — le# V { JOB ADDRESS AND OC TON'. r< - ----( -------.- ---- �`'�r'�71----------------------------------------------- _ . Owner's Name. - -,-...�1-j ( --�------_- . Phone- .... Address7�.{ ' 1"1E' --------------•---------•-••---------- ----•--------------•-------.--•-----••------------------ Contractor's Name--- Z AV------------------- ------------------------------------ Phone-----_---------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: _ # Number of bedrooms __ Number of baths Lot size � � Q� __ ___-----------_---------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 34 eet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay.[] Adobe ❑ Hardpan ❑ Previous Application Made: (If yet,date--_.____..__..__.._} No [Er New Construction: Yes VJ- No ❑ FHA/VA: Yes ®—Na, TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from'nearegt _____________Distance from foundation---49---------M.atelriaL_ .C�__#�/` ..______.__. No. of compartments__._��._____-------------- _ `�Liquid depth__��..______..capacity_ ----- ---. Disposal Field: Distance from(neare�s1t well_____ _____Distance from foundation___1�_*-____.Distance to nearest lot line_ �._____ Number of iines'_._s�-__ _Len Length of each line_ Width of trench_ `__ ---------------------- ---Total-length - ------- g09---,-. Q _ Type of filter material_/�4Depth.-of_filter-material _ ___Total length- �' _:___________ ------------ Seepage Pit: Distance to nearest well----------------}------Distance from fou'..Size:: a to nearest lot line-�~_____.._ Number of pits_ y�` _.__________Lininsg material__�Q� ..Size:.Diameter__. Depth_ _ .___ } Cesspool: Distance from wrest Weil--__.______.__Distance from foundation___.______,______.Lining material--.-- ___._______.________________ ❑ Size: Diameter--*----s--=------r--- . -------Depth------------------------------- --- ---------------Liquid Capacity-- i------------------ ;----gals. , Privy: Distance.from nearest well_______._I--------------------------------------Distance from nearest building______._______..___________-_- ❑ Distance to nearest lot line-- --- - '------------------ ----------------- Remodeling and/or repairi (describe)' -------------- ------------------ ----------------------------- -------------- -- ------ ------------------------------------------------------ =------ -------•----------- - ------------ r = --------- -------------------- ------------- `------------------------- ------------------------------------------------ ------------------------ --- I hereby certify that 1 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. t f [Signed} � � ----------- --- --------------- - - ------------- ----------- --I�br Contractor) By--------------------- ---- == -[Title)=� � � �...---- .......... �t[ (Plot plan, showing size.of';lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). 1 + F I FO;R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------A—/----------ArDATE __ REVIEWEDBY---------------------=-------------------------------------------- ----- - ------------------- DATE--------------- BUILDING PERMIT ISSUED----------------------- ------------ fr - DATE-------Y----------------------------------------------- Alterations and/or re m end tign :------ �. j ---------------- '�` ----- V C`Z . -----------------�Z:-----... c--- ---- ...... h• moi. _ - -------------- �� , FINAL INSPECTION BY:------ ----- '------ Date--------------- ---- '�' SAN'JOA( UIV L:OCAL"HEALTH'DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street_-3 ! -i i West 9th Street Stockton,California Lodi,CaliforniaManteca,California Tracy,California Gip 9& 9 REVISED 8-59 3M 3-'53, 120. � / !� R`