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FOR OFFICE USE: ------------------------------------- --- ----- -------- APPLICATION- FOR SANITATION PERMIT Permit No. .1... [Complete in Duplicate] ----------------------------------------------------- -- This Permit Expires 1 Year From Date Issued Date Issued -------••-•--__-Zf.6 Application is hereby made to the San Joaquin Local Health District fora permit to construct and'instail the work herein described. This application is made in compliance wi�County Ordinance o 549. ,�w�1 r Z�S—(S-o'AND- � /�_ JOB ADDRESS AN LOCATIO ,�,: !is'! '-- -- ---- •- t � ? x 'U� {• ��, 1 i Owner's Name � 1/ -•--------------------------------------------------------------- Address ---•-•------------- -------------- --- Ph ne-.: Q � �._ _, -- ----------- - -- Contractor's Name _ :_ ._� ff ---•---=--------- - Phone.... Installation will serve: ',Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L Number of bedrooms%._3_-_ Number of bathe_ Lot size---- _____________________ Water Supply: Public:system ❑ Community system ❑ Private 2--Depth to Water Table6c?_ ft. z Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand -Loam I] -Clay Loam V?" Clay ❑ Adobe ardpan Previous Application Made: (If yes,dote._-___-. .--- --1 No New Construction: Yes No ❑ FHA/VA: Yes J�-�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: x .' T..... ;,..• ! �. Nose tic tank or cesspool permitted if public sewer is available within 200 feet ' -..�.�e...a.t �+r,....� - �... K -�—•—, _ "= ---a!e';�'"°F-'r-^ti..r�-- /�-+w.c..n�:rr,:— ` '- _a*f= Septic T Distance from nearest well-,57P. Distance from foundation_�4J---------.Material_-.-_ P__2ti l-------------------- No. of compartments--_.-5 ---------------- �� Z _l�!�__Liquid depth---^/__ --------------Capacity.,/s;1L/` Disposal eld: Distance from nearest.well---<'��_-_._._Distance from found /ation_. � / Distance to nearest lot line_.; _________ ly' r / �j ' Number of lines--------.-a-___�________________rLength of each lines�1--'_'�}e-�_�_._Width of .-----___...- Type of filter materia{= /__ate_*��_1�Depth of filter material___, _ _-/......Total length---------I Seepag it: Distance to nearest well--1-60--�_-_EDistance from foundation./_0___ _-._,_.Distance to'nearest lot line-__�_------_ 0 Number of pi ________________Lining material_: _ ,( __--Size: Diameter.ti?-_�_�-----.._--Depth`a�sta,��-er1 �_ _ Cesspool: Distance from nearest well---------------TDistance from foundation__%--------r^---.Lining ---__.__-_________-_____-___. Size: Diameter----------------------------------- -Depth--------------------------- =J yY Liquid Capacity- -1�----------------------gals. ' Privy:-'^ Distance from nearest well-------------___.___:.___.______--- Distance from_near_est building--,_,---_--___--___--__---_-----.--____-_. ❑ Distance to nearest lot line_ ___------------------___ - t d Remodeling and/or repairing,(describ'e,} -- :--`__---- --'.,�%f _-- ---_-, 1 --------------- -------------- -------------- ------------------------------------------------I---------= ---- �-------------��----- -------------------------------------------.------ --_ - -------------------- ------ i _ _ ----------------------------------------- ------4---------------------------------------------------- -. -•---------- -- �` _____ _____________ ______ ______----__---------- j I Hereby certif _'that,'I'have-pryp "d-this-:application and that the work will be done in accordance with San Joaquin County ordinances, State`I"w and rules;.nd a lations of the.Sati Joaquin Local Health District. (Signed)---------- ---- -• -----------=- - ----- ------- ------ - --- -------(Owner and/or Contractor) J� ; $y:------------ ------------------ - ---------- -------(Title �. `� - ---- ---- _t.ra (Plot- lari;show' size of`lot;location of system in re a�tion to yells, buildings;`.-etc.;-can=-be-placed-onsreverse-side)..�-_�_ ( P ' FOR DEPARTMENT USE ONLY 1 r ;. r _ ) APPLICATION ACCEPTED BY- ------------ -------------- - --- ------------I------- - �l-"DATE---------- b l ----------- �ti REVIEWED_BY----�-- = ---- - -- DATE------------------------------------------------------------- I BUILDING PERMIT'ISSUED------ ------------------ ---- -------------- ,--;—--------------- DATE Alterations and/or recomm-emendations:-.,//- ---� `-- -.'--- -- Ig ---- QN)---- -- 7AR1�PR�---:=----- S---Q-iX-------- ------------------------- ----- ------------------------ �._ ..(_ ----------- ------------d? 1'Tl ------------5--`---.�k�._-�`�------- ---- ------------------T,X a. 1-�- '^� o y -------,din _j>-- --------------14p-�_t'A�f-------3Q.:....yo--------- ---•----------------------------------------------------- --- ------- -- ------ --------------------------------------------- ----------------------------------- ------------------ --- ``-- ' r- ---------------------------- -------------------------------------- - -------------_------------ ----- ---------- y FINAL INSPECTI :- - --� --- -- ---- -------=- Date r ----------------- -------------- ► : SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street f Stockton,California Codi,California t -Manteca,California �" _ Tracy,California ES 9 REV15 tEV 8-59 3M 3-'63 F.P.CO. 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