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---------------FOR ---O---F-F--I-C--E---------= ------ ----------------- - -- -- - - ---------------------------- y APPLICATION FOR SANITATION PERMIT ANITATIONPERMIT rPaerm it No. 1eL 7 _ :�� (Complete in Duplicate] f� Date issued ----•- - 15"------_---------_f- ------------------------------------- This Permit Expires 1 Year From Date .Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work.heceirl described- } , This application is made in compliance with County Ordinance 54 "" — ( � � JOB ADDRESS AND CATION" _ __.._- - -- -- -- -------- ----- ---------- -- --- - ----- ----------- ---- . •�?' Owner's Name-- - ---•--------------•---- --t------ "-Fes.'''"`-!-----------------=--- -------------------------- ------- ----------- Phone-------------=-----7i70 Address ' , ----�--��-- -------•--- - 6 -j-. .. N C � - Contractor's Name ..... -- --------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- !' Number of bedroom---- Number f- caths ---- Lot size --:��- Water Supply: Public system Elil;Community system ElPrivate Depth to Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam n Clay ❑ Adobe ❑ Hardpan k Previous Application Made: {If yes,date.- --.._..._.._j No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE:OF INSTALLATION AND SPECIFICATIONS: ; -(No septic tank or cesspool 1permitted if public sewer is available within 200 feet.) Septic/Eank: Distance from nearest well----��d----Distance from foundation-------Z-0_-----Material----__ ___________________ [� No. of compartments_._--__.--7-------Size__ ___4_:;ry--d'�.Liquid depth...... ................. .Ca acit - G from nearest well....�_I_�--___--Distance from foundation------ ...-----Distance to nearest lot line_.�.�. __ =_ F` Dispos Field: Numaberr of lines-_------ Length of each Gne____-_�- --`__:____.Wsdth of trench._.._._ �_---:-.--.---.__-__ .r 0 � _ Type material-4- ---x----_.___Depth of filter, material----._-f :.----"--"-Total length---._._r_U____----------------------- S:. ------------------- S:. it: ' Distance to nearest well-------1049-._.___Distance from -fro ndation____--JV______.Distance to nearest lot l�e____-rn__-__.. T e o iter F S N nbe`r-of its----_. _ --_Linin! material.. ............ ': Size: Diameter.__ _. ti ____Depth___ ..---_-__-- - Cesspool: Distance frominearest well-------------A__Distance from foundation--------------------Lining material------------ 0 Size: D'.iar[ieter+_--'~ _ "�- •'-------------DepthLiquid Capacity :-------gals. Privy: Distance..fromi,nearest well____________________-------- _____________--_---Distance from nearest building-------....__________----___,_.---------- . # ❑ ;Distance to nearest lot line l -------------------------------- --•------------ --Remodeling and/or repairing (describe):----.. -- ----- -- = 1 II ) -- --d' ---------••- --------•--------------------------------------------------------------------------------------- --------------------------------- ------------------ - ---------------- o ----------------------".�_-- ,= — -------------------=---------------------------------------- -----------------------------------------------------------:------------=------ 1 hereby certify that I have prepared'this application and that the work will be done in accordance wifh San Joaquin County 1.11 ordinances, State " , and rules and reguletidns'bf fh6 an Joaquin Local Health District. .t Ih ..,(Signed)--- By: _,, .[signed) ___---�- - _ --- -- --- °rte By:----- ----------- ----- ----------- -- - - --------------- ------ ----- ---------------------(Title)------------------------------- --- -- -- ----- (Plot plan, showing size of lot, location of system in.relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - =------------------------------- DATE---- �.. - �b --------- REVIEWEDBY------------------------------------------I-- ---- -------------------------------------------------------- DATE_----- --------------------------------- --------- BUILDINGPERMIT ISSUED-------------------------- --------------------------------------------------------------------------- DATE--------------------------------=----------------------------- Alterations and/or recommendations:--- -------- ------------- ---------------- -------------------------------------------------------- -------------------------------------------------------------- -----------------------------------------------------------------------------• ------- - -- ------------ -- •---------- •----------- - --------- - - ------------ ---------------- ZI FINAL INSPECTION BY:.. ----- V, ------ Date-..-----: 'r Y" 7 -- ---------------------- ---------- SAN JOAQUIN LOCACHEALTH0i' fRICT�, I 1601 E.Hazelton Ave. 300 West Oak Street 1:24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 6.59 3M 3-'63 F.P-CD.ji � 1' Y