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,,F Fl` 10E USE: - __...-.--______________ _ APPLICATION FOR SANITATION PERMIT Permit No. 1..Z-3.G_� _ - -----•-••---------------- ------------------ (Complete in Duplicate) Date Issued ._....30>/� 7 .._ ....- ------ I ------------ -_. I --- I This Permit Expires 1 Year From Date Issued 7 Application is hereby made to the San Joaquin Local Healfh,District for a permit to construct and install the work herein described. This application is made in compliance with County Oroinancei No. 549. JOB ADDRESS AND LOCATION_. 3 la .../.... �1 •-- ---------------------------------•---•-----•-----------------•---------.... . Owner's Name---/.^ T�1'1-- F' G� 'S,Qr-------• ----- Phone-_ --------- ._ ...--•-----...... Address -------- g,;_2 3 ftxk---- ---- -- •----•---- Contractor's Named ....-- ----- - _............. -- -- Phone_. Installation will serve: Residence Y�'''A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living s:unit.. / x/"/.o L... Number of bedrooms _�._ Number of baths .f ..-. Lot size ......74................................................... f Water Supply: Public system ❑ Community sysi•em ❑ Private ❑ Depth to Water Table l.'? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [4--I1_ rdpan ❑ Previous Application Made: (If yes,date-----.-. ._..... ) No�New Construction: Yeso El FHA/VA: Yes D No Pe—` TYPE OF INSTALLATION AND SPECIFICATIONS: { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well.?-�p.fi.Distance from foundation_-lQ__--_.....Material___��----------------- No. of compartments...._Z--------------- Size ---- 47X-.:Y-----Liquid depth.... -------Capaeity._,O .?---k Disposal Field: Distance from nearest we I_.- %2-".t-_ Distance from foundations? ?q-.___-_.._.Distance to nearest lot line_:- ..- Number of lines_.___ --------- .... of each line.7s.a� /---------- ...Width of trench- Type of fuser materia T�%1 a.�_<< _.Depth of filter material ._te--- --_--Total length_--_-1��'c�-.--_______________ / I y Ul SeePit: Distance to nearest welt:.%a G'..........-Distance from foundation.-�C_.-._--_... Distance to nearest lot line .... uJ W Number of pits ----- .a•-_......... Lining material.......Size: Diameter. r�...3...__ _.. Depth...... _ 6 Cesspool: 1star.ce f om nearest well.................Distarce from foundation ........ .---- ...Lining material......... ........................... ❑ Size: Diameter-------------- ----- •--_---------- Depth --------- -------------------____ -----------.-Liquid Capacity ---•--••---- --------gals. V _ Privy: Distance from nearest well.. ................................... ----------- Distance from neerest building .......................................... e+ ❑ Distance to nearest lot line ------ ......... ............................. --------------------------- :............ _...................................................... Remodeling and/or repairing (describe):...................... --1---------------------------------- ------------•-------- _..-......................._......_ ._..........---.-•-•-------•--•---------------•-. •-•------------------- -•--...... _....---•-------------------.._._..----•--•----•------•-•-•-------•-----•----- ...- 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 an regulations of the San Joaquin Local Health District. �?f �swyt RrLG..� r� --..(Owner and/or Contractor) (Si 9nod )- .................. - -- - By-__=------------------------------------------- -----------._....---.------..- - --• -- {Title).-... --- Wn-7- o"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 -------- ....... .. t v.-------•-----------------------------•-•--•------•---•----- DATE.---- "... REVIEWEDBY----............................................................... .__..................................................... _ DATE.......... ..................... BUILDINGPERMIT ISSUED___ ---- .......... ...------ ..----•--------------------- ------------------ _.-_........ ------- DATE ---- ............ Altera ions and/or recommendafions:...... .............._._._....._-_................_____ _ r _..-. -. y.Y...Y.--c'....................... -.._= ._..._.-.....-------•------ --- ---------- ----------------------------------------------------------------------- -............................................... ............. -------•- ---•- -.. ----••--------------------------- FINAL INSPECTION BY:. ....... .. ! ......_... Date........................ .__....... S JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California E5 9 RCV19ED 8-59 3M 3-•63 F-O.Co.