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FOR SANITATION PERMIT APPLICATIONPermit No. _.�(,r�..3:3..1-•-- (Complete in Duplicate) Date Issued _71!-216v 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. �g ----------------------------- JOB ADDRESS AND OC TION-------- �+�--------------- ------ ------------------------------------------------------------------------------------ Owner's -- -----------------------------• ------------------------- �f/LQ.s. a Owner's Name----- - ------- - ---------- -----�-�'",r-"_'"-------------------------------- ------------------------------------------ -- Phone- ----�- ---•-------•--� Address �'�1� ---•---------------------------------------------------------------- •------------------------------------------- 7 Contractor's Name------- �.----- .. Phone _..... -'� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I-.. Number of bedrooms __ --- Number of baths ---I--. Lot size _-..�`"o3c �s Water Supply: Public system [� 8mmunity system ❑ Private ❑ Depth to Water Table 14it. Character of soil to a depth of 3 feet.! Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes ❑ ,No E&/New Construction: Yes Rj.-No ❑ FHA/VA: Yes ❑ NoL:�, i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-------------_-Distance from foundation-------------------Material------------------------------------------------- El No. of compartments------- -----------------Size----------------------------- Liquid depth---------- ---- ---------Capacity----------------------- Disposal Field: Distance from nearest well..""---------Distance from foundation...-_JW �-------Distance to nearest lot line_-,'S_---- r Number of lines.-_).--------I--------------------Length of each line-------I?_ .----.--...Width of trench...... �J - -_ - Type of filter matenal-��4_C<.�_-_----Depth of filter material-----------------------Total length----,..�------•--------------------___-_- Y-r �,� �I - �r � Seepage Pit.: Distance to nearest well----- from foundation...r_�,Q.._._.._._.Distance to nearest lot-line__`__....�� Number of pits--_-)---_.I--------Lining material r�_ ------.Size: Diameter.-_.-fir ..y..----Depth.-.---_,_2_4�7---- 4 x,- I Cesspool: Distance from nearest well.................Distance from foundation-------------------.Lining material__.--_----------------.-._._-------. Size: Diameter----------------------------- ------Depth--------------------- -----------------------------Liquid Capacity- -------------------- ----gals. ;� ❑ ' 1 Distance from nearest well----------- -------------------------------Distance from nearest building Pavy❑ s, g [�1 Distanceto nearest lot Ime---------------------------------- ------------------------------------ -----------------------•---------------------------------------- Remodelingand/or repairing (describe):------_----------------------------------------------------------------------------------------- -------------------------------------------------------- } ------------------------------------ -------------------------=-------------------------------------------------------------------•------------------------------- --- - ---- -----------------------------------------------------------I-------------------------------------------11---------------------------------------------------------------------------------------------------------------- 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 and re ulations of the San Joaquin Local Health District. (Signed) i --------------------------- ------------------------------ ---------------------------------(Owner and/or Contractor) By:---------------------•--- -------- ' --------------------------------- ...........••-----------------------)Title)---------- ---------- ----------------- ---- ---------- -- (Plot plan, showing size of ocation of system in relation to wells, buildings, etc., can be placed.,.on reverse side). ` r FOR DEPARTMENT USE ONLY 1 - ,� DATE------ ----------------- APPLICATION ACCEPTED BY.. -.. `� u �r------ REVIEWEDBY----- ------------------------------ ------------------- -------------------------------------------------�L DATE------------•-------•-------- --------------------------- BUILDING - -BUILDING PERMIT ISSUED----------------1---------------- ---•---------------------•------------------------------- --------- '.DATE------------------------------------------------------ Alterations and/or reco mend tions:'---- ----- -- ------------------• ----------------------------j-----------••-----------------••-------------------------------------- .LrS � :_�d��L1c 'C_ `---------•------ = G ` ' ------------------•---••-•-------- ----- ----- ------- -------------•--------- ----- --- - -- ------- ---------- --------- - -------------------------------------------------------------------------- FINAL INSPECTION BY:._ ..- u � (�d --- �--� - -=- - --- - -------- Date------ --------------------- ----------- ------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130,Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.CO.