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---------------- `-------- ----- - APPLICATION FOR SANITATION PERMIT Permit No ------ mplete in Duplicate) (Co This Fermlt Ex"fres 1 Year From Date Issued Date Issued Application is her made to the San Joaquin Local Health or District f ��3x This ap♦plication is made in compliance•wifh County Ordinance No. for a permit to construct and install the work'herein described. P S } 9. JOB ADDRESS AND LOCATION__-__-_ •--_. "I Owner's1.Name-_-_- 1- .- ------- ---- T = - �� ------- ------------------------ Address--tPhone- 'a-_,j D k -� ► :: Contractor's Name _ -y` `� = vSL�Y` 1 Installation will serve:. Residence ------ , �-y`-0---•---------- _ ----------- Phone----- A---�--q Apartment House , ' `` ' - ❑ Commercial ❑ Trailer Court ❑ Motel ' Number of living units: .-- ❑ Other ❑ g ---- Number of bedrooms __txi._ Number of baths __-_°k�Lot size -____jj _-ln-, _X- 5 Water Supply: Public system - ------------t Y ❑ Community system ❑ Private �( Depth to Water Table -�.ft. Character of soil to a depth of 3 feet: Sand it ❑ Gravel ❑ ,Sandy.Loam ❑ Clay Loam [] Clay ❑ Adobe { Previous Application Made: Of ye4s,date______________€_ } No �j New Construction: Yes & Hardpan ❑ i ce` .... ❑ NoTV Yes ❑ No TYPE OF lNSTALL`ATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)Se tic Tank: Distance from nearest wel-.�j_--- I of Distance from foundafion--.:._ _47-.____ ` 4 No, of compartments- � L .Mater'ai-.-_____ -------�'=-- ------ -Size.- ---- l � , t �-`=]..Sf�-�`--�- ---�---------- Dis osal Field: ,., T h-�=X -Liquid depth--____-- ---- p Distance from nearest well_-- -'_. Z; � Z ---------Capacity..�af�--- al Distance from foundation......)D__ Distance to nearest lot line__ ' Dumber. of lines_---._-_--- Length of each line------------`� - -----Width of trench-------- 2 -T-- - Type,of'filter material-__ ' D�_1_�---Depth of filter material-------- �-"----Total � � - Seepage Pit: Dis#ancefto nearest well-_- length--163 -1. r - -� -___Distance m foundation--.__ --0....... to nearest lot Number of pifs--- _-----_--Lining material_- D- � 3-"- -.Depth_-- t line--:._- _'_ rj � SDiameter Cesspool- g -------- ----------------- '--�- I p Distance from nearest wellDistance from foundation- ma#erial___-__----- ❑ i Size: Diameter-------------------------------------- Depth -------- ------- ► .. + . -------�------Liquid Capacity_-- els. 171 Privy: Distance from nearest well---___________ --------------------------------Distance from nearest Distance to nearest lot line----------------- - ----------------------- • r - Remodeling and/orI repairing (describe):----_- -------------- r ------------------C -------- _..----- � ------•----- f ,-----------•---------•------ ------------------------------ = ------------------------------------•--------------- ---.----- ------- - I hereby certify that I have-pFepafed this application and that the work will be done in accord1. ance with San Jo ordinances, State laws, and rules and regulations of the San Joaquin local Health District. aquin Counfy (Signed)---- ------------ Signed)-- r ° ---- - --- - �� -- weer By: -- /�'r Contractor ----• --- {Title) -t�--.(,rR,yl� t - - (Plot plan, showing size of lot, location of stem in relation.to wells; buildings, etc., can be lac 0 - -.:.- E placed on reverse side). .'1[ t__.1__"FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY ___ � �- REVIEWED BY DATE DATE ----------- BUILDING PERMIT ISSUED - ---- - _ ti------ ----------- --------------- -------------------- ---•--- Alterations and/or recommendations:------. __ Irsr_ ,rte - DATE---- 2wC'L_Yr9 ,-tv - p.�- G —7 ---- -------- ---------- 1 ----- # ----------• i •-- = h ----------- -------------------- FINAL INSPECTION BY:-_--K�Y -- - 0Date- S_ - - " �. SAN JOAQUIN LOCAL HEALTH DISTRICT i' 1601 E.Ha:elton Ave. 300 West Oak Street 124 Sycamore Street ,Stockton,California Lodi,California 205 West 91h Street Manteca,California * 7 ES 9 REV$SED B-59 3M 3-'63 F.P.gip• Tracy,California l� a