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FORS FENS USE: - ------------------- Permit No. APPLICATION FOR SANITATION PERMIT ------------------------------ -------- ---------------- f (Complete in Duplicate) Date Issued ----- _-- - _v9�^ d"_. This Permit Expires 1 Year From Date Issued 19 7 , 0?0 ,« Application is hereby made to the San Joaquin Local Health District for a permit,to construct and install the work hereeesc in -1 TcA This a plic ion is ma�L�C n compliance with County Ordinance No. 549. w 1 y kenI � ,` I'D � � J 4h 5--E7 ^ -- -� JOB ADDRESS AND �+TION------- --- o��-�------ 1 ------------� - 1 4-��[ G = _ 5_ �-" . Owner's Name 1_Z.- -- pp ! ------- Address----------- �° Contractor's Name----P-]C IV�K------------------------- -- "-`---------- ---------- ----------- Phone Installation will,serve: Residence FT Apartment House El ��Commercial ❑ Trailer Court ❑ Motel El Other El 11 Number ---- Lot size ---��--�•-- 1:_p--U{------ ---------- ---- ! Number of living units: --�.--_ Number of bedrooms --", "_ Number of baths -� Water Supply: Public system ❑ Community syst ❑ Private ❑ Depth to Water Table -"- ft. Character of sail to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ .Clay Loam '❑ Clay 0 . Adobe❑ Hardpan ❑ New Construction: Yes o ❑ FHA/VA: Yes ❑ No Previous Application Made: (If yes,date--------------------) No ®� TYPEYOF-INSTALLATION AND 'SPECIFICATIONS:"'" (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; Septic Tank: Distance from nearest well-----------------Distance from foundation----------------.-_Material -___..-___---.._.----.----------.-__-.-.--_-.-. !I ]�_)ouv1 r4 No. of compartments-----------_-------------Size------------------------------Liquid depth----:---------------- CaPacity------�� Disposal Field: Qistance from nearest well...-�? --- Distance from foundation---_f --.__--.Distance to nearest lot line_--"___---_-..__ � Len th of each line------.7 ---- Width of`trench--_.--. ____-- ------- )f4 Number of lines------------- -- g l I Type of filter material--/ &C-t< -,Depth of filter material___" _.---------fiotal length-__._"- ___- - _______.------- I Seepage Pit: Distance to nearest well._____-_-._._._--.__:'Distance from foundation-�_-___-..._---_.Distance to nearest lot line----------------- ❑ Number of pits--- ------ --------Lining material--_ --- --:�-- -----Size: Diameter.--- ------ --------DePtsn--------- --•-------------- Cesspool: Distance from nearest well-----------------Distance from foundation...___---.-.-.."..Lining material------------------ als. � Size: Diameter------- ------------ ---------------Depth: ---------------------------- ---------------.-Liquid Capacity----------------------------g ❑ Distance from nearest building-----------------------------------------f Privy: Distance from nearest well----------------"---=--- --------- ❑ ---------------- ------------------------------------------- ------ Distance to nearest lot line-------------------------. -- ,- Remodeling and/or repairing (describe):----------- ------ --------------- -------- ------------- l i ----------------------------------------------- 1 i � `�5- 1 ---- f-------------------------- ------------------------------ ------ ------------ ------------------- -- ---- --- ------ ,.. I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State,;lawsf and rules and regulations of the San Joaquin Local Health District. { '�G1""'b{ A.IJ" / �E' � -------------------------------- (Owner and/or Contractor] - Si ned - - - - _ i (Title)------------------------------------- ----- -------- - Plot Ian, showing size of lot, location ----------- ells,-----------------------------------in ( p ocation of system in relation to weNs, buildings, etc., can be placed on reverse side). ----- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY' = t t; - "...._--------- ----------------------------------------- - DATE--.-----_�_9-----Z-� �'� �- ------- ---- DATE--------------------------------------------------------- , REVIEWEDBY-----..---------- --------------------------------------- -------------li------- _- ---------------------- -------------- BUILDING PERMIT ISSUED------------- ----- '------------------------------------- - ------- DATE--- ---------------------------------------------------- -------------------------------- �� ------- -------------- ------------------- Alterations and/or recommendations;_--._....-._"-.__...______-------------------�-•------•- ---------------------------- - - --------------------------- ------- ---- - Date-------�.-`�----- --------------- --------------------------------- FINAL INSPECT! SAN JOAQUIN LOCAL HEALTH DISTRICT. 1401 E.Ha:etlon Ave. 300 West Oak Street 124�ycamore Street 205 West 9th Street I Lodi,California Manlecdr California Tracy,California Stockton,California - { • F.P-C R. � •• � „