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')----OFFICE USE: - X'4 0- _.---t 3. -j - - --------------- APPLICATION 'FOR-SANITATION PERMIT Permit No. 9 --------------------------------------------------------- (Complete in Duplicate) -- Date Issued - -------4-I---.------- -------------------------------- This Permit Expires 1 Year-From Date Issued V/16A Application is hereby made to'the San Joaquin Local'Healfh Dist.rict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No, 549. 00-0-0y JOB ADDRESS AND VLOCATION__?V4^,,L_XAak C�__A A, -1-m-'_ tAA,.-N�:-----*------ -(I-&1A&V- ------------------ Owner's Name f--- �d........ ; ---------------------- -------- Phone.-----------------------•----------- ----------- Address................I-Aa-Ax ......... 7 - -, j -----------------------------------------------------------------------I-------------------- ------------------- 104,6.ffv�j_ Contractor's Name---- T&-1-------K----------------4--------- Clamp--------------- Installation will serve: 'Residence Apartment House [:] Commergal []. Trailer Court [' ] Motel ❑ Other 11 Number of livin' units: Number of bedrooms ---!,-Number of baths ---- Lot size ------- ----—---------------------- Wafer Supply: Publictsystem.E] Community system E] Private [Depth to Water Table 16- ft. Character of soil to a depth of 3 feet: 'Sand E].: Gravel JiKS 8y Loam 0 Clay L6am [I Clay El Adobe D Hardpan El C Previous Application Made: (if yes,date____________________) No [7New Construction. Yes No E] FHA/VA-. Yes I-] No TYPE OF INSTALLATION AND SPECIFICATION (No septic fank'or cesspool permitted if-public sewer is available within 200 feet.) n__ Se f* T nk: D�Gtance from nearest well_,___$:P_1 �,ttinw frQm at ion------ Material----- --------- No', of compartments---------X. ---Liquid dep.th--------------- ---- ----Capacity Disposa field: Distance from nearest well_ . ..........Distance from, oundafion----- __t.___Distance to nearest lot line__ -gloms Number of lines------7 - I--------- ----- - ------Length of each line---------qA1_1--------------Width of—french.—__ ------------- Type of filter ;' of-filfer material-----19.............Total length---------- --------------- Seeps Rd Pit: Distance to nearest ---- ---Distance from fp-undation..-.i-O-..-�---.Distanc7 to nearest lot Number of pits---------- --------g Lining material---�_VC , ---Size: Depth......1i --------- Cesspool. Distance from nearest'well____ -----------Distance from fou-ndafion...-------.__:_____.Lining material-_-_-__.__________.____._____'__.__' 0 Size: Diameter--------------------------------.::I-Depth----r------------:---------------------- ------------Liquid Capacity-----------------------------g a S.i�9 Privy: Distance from nearest well______.__..___- n' ----------------------------Distance from nearest.building-------------- ------ ------------------ ❑ Distance to nearest lot line----------!__1_1-----S•---------------- ---------------------------I--------------------------------------------- -_---------- E Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- ---------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- --------Z ------------------------------------------------==---------------------------------------------------------------------------------------------------------------------------------------------------------------------- • ----------------------------------------------4------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- 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 SIp Joaquin Local Health District. (Signed)----------------- ____ --------- -------------------------------------------------------------------(Owner and/or Contractor) . Ti (Title)----------------------- - --------------------- --------- -- (Plot plan, showing size of-lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY-------- ------j--------------------------------------------------------------- DATE---- -------- ----------------- REVIEWEDBY----------------------- -------------- -------------------------------------------------------- DATE------- -------------------_----------- BUILDING PERMIT ISSUED--------------- --------------------- -------------------r ---------------------�;.......A--------- DATE------------------------------------------------------------- Alterations and/or recommendations: ---------------------------------------------------------------------- -----------•------•------------- ------------------------------------------ ------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------...... -------------- ------------------------------------------------------m----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ -----------------------------------------------•--------•---•--------•-•------------------------ ------------------------------------------------------------------------- ---------- --- ------------- ---------- --------------------------- ------ ----------- ------------------------- -------------------------------------------------------------------------- -------------------------- ------------------------ �--------------------------------- FINAL INSPECTION �Y:__, Date...... ! SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Are. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California �7- Manteca,California Tracy,California CS 6 REVISED 13-59 3M 3-'63 F.P.CD.