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FOR OFFICE USE: I ---------- ---b_______-.__.________�/__t'-- -- -- APPLICATION FOR- SANITATION PERMIT Permit No. l-_..�_.�_ - f ------------------------ --' (Corrlplete in Duplicate) ------------------ This Permit Expires 1 Year From Date Issued Data Issued _� � � nJ � cy Application is hereby made to the San Joaquin Local Health District for a permit to constructAnd install t e work herein ascribed, This-Application is made i�},�,co911'el ce w,i h County Ordinance No. 549. e / JOB ADDRE55 AND C T -- J � Ems'" l ' �� Zi;4� X4g3 Owner's Name_____ -- --Ave.... _4'� n �"l� +?� lm... ----------------- Phone Address / PJ.I ,C ------------------•----------------------- ----- -- -- Contractor's Name---- = • ,� ;• Eo �G J i Phone --- Installation will serve: 'Residence E2-,"Apartmenf House ❑, Commercial ❑ FTrailer Court ❑ Motel ❑ Other ❑ Number of living units: /----- Number of;bedrooms '3'_ Number of baths I_____ Lot size -------_______'_-_--_____ Water Supply: Public system ❑ Community. system ❑ Privateepth to Water Table ft. irdpan Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sand Loamo Clay Loam E] Clay E] Adobe 2--"Ha ❑ Previous Application Made: (If yes,date.__-____--1_.--------) No New Construction: Yes i2o-'No ❑ FHA/VA: Yes P---Rlo d; TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted if`public sewer is'available within'200 feet.) Septic Ta Distance from nearest well___-__Distance from,foundation_/d__ ____-- Materia4__.00_A6e1_ = X'___________._____ No. of compartments___�__-____________Sxze___ ---TLE wd depth__ Capacity--few______ d __ f� ------ Disposal ' Distance from nearesf wel�eo___ Distance from foution_,/ S------------Distance i to nearest lot Iine.�J�_--____-_ Number of lines-----------� ----------------Length of each line_7-SSf__7. ------Width of french__�_Y----------------------- Type of filter material-,/ �'_z_ e_g-Depth of filter material__1�'_�___1-------Total length------ f__________________ /__O. Seepage Distance to nearest well__ -O----------Distance om foundation____ _ ___________Distance to nearest lot line_..5---- y Number of pits____ Lining material___ 4_k_VW7----Slze: Diametei-3-S J-__-__-__.Deptn`._c Cesspool: Distance from nearest well-----------------Distance from foundation.___________-_:-_-_.Lining material-_-.__-________________________-_____. ❑ Size: Diameter------------------ ------ ------=--Depfh-.:r----'------ -------------`----;-------Liquid Capacity--------------------------_gals. Priv Distance from nearest well__'__'____________---------------------------------Distance from nearest buildin ❑ Distance to nearest lot line_____ __________________'________ "-� o Remodeling and/or repairing (describe :----------------- -- --•-- L__ •--- - _".�„_ '--------•-------•-- -__-• --•-----.• ------------- --------•-------- -- ---------------------------------------- ---------- ---------------•- ------•----------------•---------•----------------- --------------------------------------------------------- -------------------------------------------•---------------------------•--•1----------•------------------- I hereby certify that I h prepared this application and that the,work`will be done in accordance with San Joaquin County ordinances, Sta a ws, and les nd regulations of the San Joaquin Lacal Health District. } (Signed)------ ------- ----- -- -- ---- -------------- ------- - ---------------------------- -- -----.-.(Owner and/or Contractor) BY:------------------- •-------- - ---- - j----------------(Title) (Plot plan, showing si of lot, location of system.in relate `wells,- buildings; etc., can be placed on reverse side). ,d,. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------fit k------- - ----------------------------------------------- DATE----) _ ------------------ REVIEWEDBY--------------------------- -. i -------------- --------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------- ---------------------------------- r= ---------------- DATE----- ------------------------------------------------------- Alterations and/or recommendations:__t `?�_ Z_4_ f - ------I-------. ".:& >1--_`-----___�2p_ _ _____),I, ______ ------- --` - I----------------- -----------------------------_---_ "_ - -----------------:--------------------------- ------ -------------- ---- ----------- --------•- -- - - - -- - - - - - - - 5 --------- '� ----------------------------------------------------- - ------------------------- s -2- ! FINAL INSPECTION BY:----C `--- .72 --=-- ------------------------- Date------ ->----------------- ----- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ; 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California ES 9 REVIVeD 8.59 3M 3-'63 F.F.CC.