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' 0" -'OFFICE USE: APPLICATION FOR OR SANITATION PERMIT Permit No_ ____.............._ (Complete in Duplicate) a ! Date Issued I ------ -- -------- ----------- ---- --_--.------------- , This Permit Expires 1 Year From Date Issued Applicat.ion,is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I T.his_aygplicafion;is.made.in compliance with County Ordinance.No. S49f0A+%rrEC44Cj N'7�Ga!Q'-: .-f�J_`,�� '--> • f i f JOB ADDRESS AND LOCATION__�J ----- ---1.�/:�-N�._.i__E��-----/I/-- '�+�---��---___:[__I<IA_ _ _ ± --.-- Owner s Name-- F t l _f ..._.. - C ---------------------- -------- Phone-_ ------------------------------- Lill _ _`IA'ddress----------------- `` C� - i iU'�( �� J .fl= = ----------- ------- -- l40 ntracfor's Name-- .----•------•-•------------------••-•---------------------------•-•--------•----------------------- Phone------------------•-----•---------- Installatiori will serve: ,Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other�❑ Number of living units: _ -___ Number of bedrooms 02—Number of baths --------- Lot size -___---__ pjj_ Water.,Supply: Public}system^❑ ~Community`system t❑"Private�]� -__Depth to Water Table l ft, -Character of soil to a depth of 3 feet: Sand m Gravel ❑ Sandy Loam ❑ Clay Loam E'- Clay ❑ Adobe❑'0%Hardpan ❑ :Previous Application Made: [If yes,date---------------------- No [INevi Construction: Yes E4—Flo ❑- FHA/VA: Yes ❑ No T � T1(PE.OF;INSTALLATION AND.SPECIFICATIONS: ptic tan :or cesspool permitFed tf public sewer is available witkiin-2�0 feet:] Septic Tank: y-- f Nu ?f t r Disp sal :Field: Distance from nearest well--��____{Distance from faundation____�r�'__-_-,_Distance to nearest lot li'e �____....- L ' rnber of lines______________ Len th of each line___:_f__'C�j_____... ---- of trench___.__._,_ v� ,----------------- 9 -------------------- 11 fir Type of filter mattrial---hL%_�_ ---!J _7_ Depth of filter material ____________Tat.Tat.61 .� } Seepage Pit: Distance to nearest well IC _"___Distance from foundation-----/I Distance to nearest I� line__--- Number of pits.______ ___________Linin rnateraal--__! .- -. Saze: Diam er _..De th_____- _f l q a l & p E Cesspool: Distance..from nearest well------------______Distance from foundation--------------------Lining material..........---------------- ________- ❑ Size: Diameter--- ------ = Qepth--------------------------------------- ----.-Liquid Capacity---------------------------gals. fl Privy: _Distant e from ti arest,welL_______________i---------------------------------Dis.tance from nearest building.__._.____-___--- .__-______-__..___.--- ❑ Distance to nearest lot line---------------------------------------------- Remodeling and/or`repairing (describe): - ------'---'------------------------------------------------------.•-------------------;------------------------------------- ----------------------------------------------------------ti it k 4 if . - t _______________________ '-_------.--------------______________________.__________....___-.._-..__ 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 rulei"and regulations of the San Joaquin Local Health District. (Signed) ---------------- _ = f ........' -------------------------------------------------------- ---- (Owner and/or Contractor) ---------- ----E -------=--------n-- --------------------- --------------------- ---- -=-- �[•Title}-- --------- -�_ --a.3.r.,�� ::�.-- (Plot plan, showing size of.lot, location of system in relation to wells, buildings, etc., cah"be placed on reverse side). .: FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY -. f -V-`--------- -------------------------------------------------------- DATE-•---•--�{ - z REVIEWED BY------------------- --------- t - - DATE-------- - BUILDING PERMIT ISSUED...........1_1---------------------------------------------------------•----------------------------.DATE------------------------------------------- Alfierationsand/oFrecommendations-:------------- -----------------------------•-----------------------------•--------------- -•------------------------------------•-------------------------- y - -----------'---------------••-----------------------• --------'----------------------= s` --- -- ----A-�_t..t€ 4+ ------------------------------------------------------------------------------ --- •---------------- ------------------------------- ------------------------------ --------------•------------- -------------------- ---------- --------- ----------•- ----- -- ----- --- -----------•------------------------ --- ---------------- ----- ------.... ------------------------------ ------ ------ O � / �FINAL INSPEC - ------- - �.-- ---=- --- ------------ SAN I JOAQUIN LOCAL HEALTH DISTRICT 4 1601 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CD.