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t Fort OFFI-CE USE: .^ f �S�-------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No -..__-_._ Cont late to Duplicate) T '`4- . ,-f P Date Issued ��__------ ------------------------ -SJ - --.--- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance.No. 549. r JOB ADl7[ZESS AN O;CATION T 11----------1.-1 ---------=lz Q--------!-a----- C�TTI�-,----A\I.1�----•----------- Owner's Name-------------=--- IR V� - U- =�'� ------------ -------------------------------------------------------------- Phone--------=-------------------------- Address---=- — Q (- I-A ' x . ---------- ----- --------------}---- ............... Contractor's Name---------------CJ__I/!N E-IR----•------------------- ---------------------------•------------------------------ Phone----------------------------------- Installation --�-- , Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number o aivingmunits: ----.- Number of bedrooms 2-----Number of baths -_/__ Lot size -'S-7._ -X__---Z7V__�`----- -------- ► y '� - � x„��.} +liar Water Supply: Publicpsystiem❑y,ZC m=nifyy1.system-❑ Private �epth-.to Water Table - - ft. Character of soil to a depth of 3 fe' Sand7E]"' Gravel ❑. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ Previous Application Made: '{If yes,date-------------=- 1 No ©__Kew Construction: Yes o ❑ FHA/VA: Yes ❑ No- , TYPE-OF INSTALLATION AND-:SPECIFICATIONS:._ _ ,,.- •„��, _ -(No septic tank-6r cesspool-permitted if public-sewer is available within 200 feet.)•• Distance f Septic Tank: [ o ' N . of compartments.,-.-. -_ -Size from fouric�ation---_,�0__-__--.Ma�erial-- 1� �l�f - 1 Dironearest welpm l _� -_ Distance - r 1 0 X Liquid depth `— Capacity f�{, a.61 i - ► 41 w VV }It std Ze Ju p 112-A-----Distance to nearest lot line--S-___ Disposal Field: Distance from nearest well-------- -----.Distance from foundation -----Length of each line---- _ �- ----------- Type ❑ N umVN ber of lines-,-------r___________•__---- S`^ _- Width of trench------- --___-_- 7 e of filter material.__ 1_- ]- -----Depth of filter material---- - _� -_--,Total length---------------S" -------------- 1 O .# Seepage Pit.: Distance to nearest well_--------------------Distance from foundation------------- _-__.Distance to nearest lot line----------------- F-1 Number of pits_i-------------------Lining material--------------------_--Size: Diameter-----------------------Depth---------------------------------- Cesspool; ----------------=-_------- - Ces❑spoal: aearestwell----- ----------Distncefro ,foundation,_r � _ - Lining material____-_____---_-----_------__ SizeDaetern : Depth ---------- --------------------------------- ._---.--. , - ----•---------- - Capacity _-gals. i Privy: Distance from nearest well----- -------------------------------------- `_-_Distance from 'nearest building - ❑ ,� Distance to nearest lot line ---------- ------------------------------------ ...------=--------------------------------- Remodeling and/or repairing (describe):----/0 t / ! ----D[— C�_�y - ---�L10--RS_ --------------------•----------------------------------- ----------------------- / i -------------------- - - ------------------- - =�L "w'"t--"°"-- ----------- ------------------ -- I hereby certify that I haye'prepared this application and that the-work will be done to accordance with San Joaquin County ordinances, State laws,;and rules andrregulations of the Sart Joaquin "" LocaI Health District. r (Signed] --------------- `______t/o_---� - _` . -- to,ner and/or Contractor) ' : ,1 t r) ,ter-' ,�„.�.,•- -- .r - k= �.. - �Y• = --- #------------------ ---- -- (Title) - (Plot plan, showing size of lot, location of system in ielation.to wells;�buildtngs,:etc can Fie placed£onrreverse.srde) � < �{ 4. FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY------ = = -- DATE - REVIEWEDBY -------------------------------------------------- DATE-------------------------- BUILDING,PERMIT;ISSUED-`',---------- ------ ---� ".� : -.--.`- DATE-_"°: - - ;.: - _ . •� ,..� Alterations and/qr recommendations: - ---- - -------- { w, T ---------------_- ---------•------------ --------------------------------------� �'4-3"qt rr��ll -------r k --------------------------------------- ---------------------------------------I------------------------------------- - --I------------------------------------------ ----• -- i --------------------------------- --- ---- --- ----------- ----- ---- ---- - -------------------- -----------•---------------- --------- --------------- A-------- --•--•----------------------- FINAL INSPEC � - Date : d --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,ka:eli Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California 9S 9 REVISED B-59 3M 3-'63 F,P.CC.