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4' FOR'GFFICE IJSE: - -------------- -- ----- -- APPLICATION FOR SANITATION PERMIT Permit No. -- - - ----------------------------- - � (Complete in Duplicate) _ — Date Issued ---T/_f.... i --------------------- --- -- ------------------ __ � This Permit Expires I 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 describe. ` •� °This application is rn!ade in compliance with County Ordinance No. 549. � ��/ ; Zc -a`Eo-�C ft cri 17 JOB ADDRESSZDLOCATION ----- i�,. ------- � I ----------- ---------------------------------------------- S' -- _-------------- ---- A----------- -- -0.. 4nfE"r------ --------.:. -'" Phone s Owners Name--------------- ------------•- =--- --- -. . .---••-•----------•-•---•----------- i Address_ _ - --- _ _ _ - ---- ----- - •-------•------------ *�' w_. Contractors Name------- - -`: ..__ Phone----------------------------------- J. Installation will serve: Residence fT Apartment House E] lCommercial {❑ :Trailer'Court '❑'. Motel ❑`a0#herEl E Number of living units: _r.____ Number of bedrooms _��_INumber of baths,____-__ Lot size -------------- --------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft: Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Cla r Adoba HardLnO)P � ❑ Y ❑ Y � Y ❑ ❑ Previous Application Made: (if yes,date--------------------1 No 8----New Construction:'Yes M.:—No ❑ FHA/VA: Yes Ej'r_ No ❑ ~+ _ TYPE OF INSTALLATION AND SPECIFICATIONS: - - T' {No septic tank or cesspool permitted if public sewer is available within 206 feet.) Se '�` J3F'D bvQv� Septic Tank: Distance from nearest welL._��Ca.-__Distant f om foundation_ _ -------- - �--�'---�------.M.at real---- --• -- -- -------'=---- --- r No. of com arfinents.__' —`P- Ca acit � Dls o al Field: Distance from near welf__J .____Distance from foundation_ �~ ' p ''-- - --Distance to nearest lot line ___ _______ a ! ] Number of lines_________':._-- ____.__Length of each line_______��_�-�_��_.WicJlh �f trench.____. ¢-- r Type of filter material_____ __ ' 1ti____Depth of filter material___-?-__ �f•_________Tot6l i length_____________ _��.--,_ �? { t I Seepage Pit: D+stance to nearest well-./P_:0__-__-__-Distan e from foundation _�0__________.�stan�c-,e to nearest lot line___ ` � [] Humber of pits__._____--_____Lining material_KC1_C�_.___.Size:'6iameter�__ Depth____...__. ---:--:--------- Cesspool: ________Cess ool: Distance from nearest well--------.__-.____Distance from foundation____`--------------I Infra material-______________r____.___.__________ 4Diameter - _ Depth = Liquid Capaeit . - Y } Pri�j3 Disftrn�e frorn neaFest well - -____ s __. from .nearest.buileling -_.-..__-_. Distance to nearest lot line..--__-_S______________ i r- — l '""-- `" """ ❑ , - SRemodeling and/or repairing {describe) t- � } s - ------------------- EY • �. i Int___f�'�. - --------"� U � .. :�:�_.1-+gip r C► =------------------------------------------ --- r yg ^.t n s € --— --------------------------------------------------------------- P �I g ________________________________ _ _ ________________1-----------------------------____i«�__.____. _ , CS .______�t. _� ------------------- 'x __-._.__.-- -_. x":`µl hereby certify that I have prepared this application and that the wo'k will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ; t {Signedj--------- '� ae ------------- ''' ---------------------------- Owner and/oi Contractor) . ••-------•----------- ---- ------==�-_---- ------------- - -�-—._ _ ____ .(Title)- q- ' ....e (Plot plan,, showing size of lot, location of system in relation to wells, buildings, etc. can lie placed on'reverse side). i _ i ; Y FOR DEPARTMENT USE ONLY } ' APPLICATION ACCEPTED BY--- .r `��---------------------------------------------------------------------- DATE----------- --"- 5 _-6-9-L -- --- REVIEWEDBY-------------------------------------------------------------------- ------------------------------------------------------- DATE----------------- ----------- _----------- BUILDiNG-PERM'IT`ISSUED_`�9-=--==T--_ ."= "-"'= ::��... _-- : _ �_.. ,� DA.TE---------.._.... , w._------...--Iw ..�_.�..-.d� �.. -. w xw-._ ,.n�iR n.,....�..-. p, t,wr � rv-�� - - . • .r.. +F ww,TY Alterations and/or recommendations __ XTT� i1 t E _ -- �/�1 [ �[ 1 -----�'r%/�- f'G�l1I /�1[�/lf`� f ----- ''+ V NTF_l Win_-----OA(.. .' W 1_V w al_,t f!! ------..flIlrR. D P141-Nf------))-T-------------- 02- S SGI ._P 16R-D----4:---.--T 3_C?C=_-H----...`T H��-----��3�_l}_.f1U� t�%�1�K�7?_----- 1� �?P�}_...__�.!_Lc�L.n!_�:--••-- FA-C - - `1 - !/. `'� r - ----_= ------1 �1 ..-...3FN------�-A1'4-------Kf��---- l'F JM-------- .......... - J. `FINAL INSPECTION $Y:_._j�� /./- Date--------------4-- - fi----------------- At ` h SAN JOA UIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street fi ,25 Wesf 9 Street a Lodi,California Manteca,California _ d 1 - y Clifornia Stockton;California Trac EVISED B-59 3M 3-'63 F.P.CC. I',Sw { Rn •. �� • rE Je tiz �#;to s n7s 1- '�