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l-UKOFFICE USE: ------ ----------- ------------------------------------- --- --------------------------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. .__ Il�_s" -------------------------- ------------ -I---------- -- (Complete in,'17uplicafe) / ------------------- --------- ----- _-=----- --- This Permit Ex ires J�Year From Date Issued Date Issued ---� Z a I Application.is hereby made to the San Joaquin Local Health /0,0— District for a permit to construct and install the work herein described. i This application is made in complian e. with G.Count-y Ordinance No. 549. F �f DE� t-�a s 1 U I JOB ADDRESS AND LOCATION- -( �`� Owners Name-.__ t ' fplY! _�..�__.. ------ '--- ' ----------`------------------------- Phone (� ..� w Address a ---------- ------�`�ANTF-09---_:___-----I----------- Contractor's Name--------- ' ,► � /1 _ - ------------ ------ Phone---------------- k Installation will serve: Residence Er Apartment House [] Commercial ❑ Trailer Court ❑' Motel ❑ Other ❑ f Number of living units. _b�,. Number of bedrooms _ 1 __ Number of baths E____ Lot;size � �2;��,��--_•---_- Water Supply: -Public system ❑ Community system ❑ Private [[Depth to Water Table . __ ft. Character of soil to a depth of 3 feet:' Sand.; -«�,� Gravel ❑ Sandy Loam ❑ Clay Loa ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes date.__._____- -ice] No New Consfruction:v'Yes pg-N�o ❑ FHA/VA: Yes Ed]"" No ❑ 1 TYPE OF INSTALLATION AND'SPECIFICATIONS: (No.septic tank or cesspool perr6itted if public sewer is available within 200 feet.)_ c e ) Septic nk: Distance from_nea; st well .7 0' nistanc from foundation___ _ r 1� 'Material__tti�C] _ > Y -No. of compartments__.__ _ -! "'Size_ X _Liquid depth- ;------.Capacity-,/A:�? 7. Disposal field: Distance from nearest.weil.,.�- Distance from foundation__ _ ,r!!�'____.___.Distance to nearest lot line____ Number of lines_____ ----...-Length of each line_-_-- i a K Width of trench__. ,"= Q' _ Type of filter maiiterial�± }'(----Depth of filter materiai_____A7__ ------ .length---------;______=S ----------- cf Seepage Pit: ; Distance to nearestwell._.___________--____Distance from foundation--------------------Distance to nearest lot line----------------- ,. ❑ i Number of pits------- ---------------Lining material------------- ---------Size: Diameter-----------------------Depth-,. '° - ------ Cesspool: i Distance from nearest well_______________f'Disfane'from'foundationDning mafe`rial____.-_ -� • Diameter--- • E 1� ❑ Size: --- --- - --'--------=---'- --- Depth--- - ---------'----- -----------'---- ------L-rgwd CapaqcitY-------- --------------- gals. 0 Privy: Distance.�rom� nearest well__._.____._____t____________________________R`'Distance�C rom nearestZbuilding_/. ------------------ : � ❑ W'14I Distance to'nearest`lot fine—---•--------------- f. — : , r�-------------------- -------------------- - _ Remodeling and/or repairing (describeF�.- ---- f4 _a-1T1_ �1t4-Lr------- 1_ Tt` -----• I yam-.----------------------------------------- ------------- -- J� ------------- ------- ---- ------------------ ----------- ----------------�------------------------------------.----- =---------------•--------------------------------------------- ----= ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances,lSfate I ws, and r and regulations of the San Joaquin Local Health District. } (Signed '----- - --'- ./� I / �'7�- ------------------------------ ------- ---'---'- � - - --------- ---'-'-- ------- --------(Owner and/or Contractor) By--------F------------------------- _______--------------------- _._______------------------------------7 �____ _ ------------ ---(Title)---------- --------------------------------'- -- ----------' --(Plot,plan.,-showing size-of lot, to ion.ofsystem._in.relafion fo,wells,,buildings etw.7 can'be placed_.on reverse.side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- :0-,.-------------------------------------------------------- ------- DATE---- --�`P-- a ' REVIEWED BY ----- ---------------- --------- ------•--- DATE---------------- BUILDING PERMIT ISSUED---------------------------- .................... - DATE - ' ------------ - Alterations and/ recommendations: -'2�►~ .- --------TAN-K---- � -} _L ----- p . 1� -------------------------------------------------------------- -----•---------- --- '-------- ------------- ------ ---- ----------- t ------------ ri y v,i y + r * ' '"�. ---------- ------------------------------- l�______..________.------------------.___________ _______________ __ _____ FINAL INSPECTIONBY -- - 1�--- -'--- - Date---'------�'� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street v Stockton,California Lodi,California 4 Manteca,California � Tracy,California 4 �E5 9 REVISED a-54 3M 3-'63 F.P.0 C. ,-';t-- -a t: