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F R OFFICE USE: 3--3 - Permit No.-------------- - .1--------- APPLfCATION FOR SANITATION PERMIT , Z7 S (Complete in Duplicate) Date Issued .--� ------------------------------------------ � • - -------------------------------------------__.._. -_._._ 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 herein described. This application is made in compliance with County Ordnance rN-oo. 549: JOB ADDRESS AND LOCATION-----------� ki � --------- -----------` !`�3 II,� - ------------------------------------ - Owner's Name-----------�' y y arc_{_= ...._ {r__ _Vic_. --- ---------------------------------------------- --- - Phone_.��_..7_`�_'. f. a--..._ Address �'67Y-----------C.ext_...f --------- 1 ---------------------•------- -�----••.......... Phoney�� Contractor's Name--------- Gt �2r. } ..- = ---------------------------------------------------------------------- - - Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living,units: _____.Number of bedrooms -__-dumber of baths ._(_---_ Lot size --_ -"-----------•--------- Water Supply. Public system Community system.❑ Private ❑ Depth to Wafter Table .0-�e ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�W Hardpan ❑ Previous Application Made: (1f yes,date----------- -----) No New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No,5�' r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation__-__---_-_.`._-_.Material_.__.-.. _____._______._________- ❑ No. of compartments---------- --- Size--------------------------------Liquid depth-------------------------_Capacity------ --------------- Disposal Fiel : Distance from nearest well'ltd' '_ Distance from foundation------6`_` Distance to nearest lot line_-----:_..--.-.-- -. - Number of:;lines____________ _ Length of each line---__-:_XLS-_-___._ .___:Width of trench-------_-� __..___-_.----- L'�•�+�.... Type.of Pilfer.material��•_ °��_,Depth of filter material------t�_- -Total length____________________s�. _______.__ Seepag Pit; Distance to nearest well.�,e'� ------Distance from foundation---.._�yI-_-_.Distance.to nearest lot line__.;3__.._.-.. �p --__Linrn materiaL_S�:�_/ Size:'Diamete'r------:-Z3.........Depth---------------------------------- i� Number of pits---'- -------- g s q Cesspool- Distance from nearest well__-- -.-_--- -._Distance from foundation............. fr _ .....Lining material--------------------__-_-_-----_-_---. ❑ Size: Diameter------i----------------------------- -Depth-------------------------------------=---------- __Liquid Capacity-----------------------------gals. v) Privy: Distance from nearest well_-____________ ______________-----------------Distance from nearest building------------------------------- -----. ❑ t . Distance to nearest. lot' line--- ---------- ----- ---------- -----------•---------- - - --------------------- --�--------••-------------- ---- ------ --------------- YRemodeling and/or repairing ;(descri6e):------- �Za---- Wit•=' `-'��. �r�n.�l gip_ �_t�•-Z--=-•------'-----'---------f---------- G i d° 4 # ---------------------------------------------------•--------------- ------------------------------------- �• r -..."------'- Is � . -------------------;---------------------- ------- "----------- # - -------------- -- --------.--- -- 4:----------I ._._._. --------'------------------`-- -------- ---- -"' -- ----- -- _ I hereby-certify, that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. / 11 )f = r 4 k (Signed)--------------------A��`�r2� -s• -� ... '_----------------------- (Owner and/or Caritractor� B •�� --------------------------------------------------(Title)---- - --------- -----}-- ------- ......--- --- Y: -- -- (Plot plan, showing size of lot, location of-system to relation.to wells,,buildin s, etc., can,be laced on reverse side). FOUR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --- DATE______'_ --- ----- ------ --- - --------- "C�`-- ------------- --------------------- --- --- REVIEWEDBY-------------------------- -------------------------------- --------------°--- --------I---------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-:--'------------I = - DATE------------------------------ - ----- ---------------- Alterations and/or recommen io = ------=- ---------------------•----------•------ -- -------- -- - :. E --"__"-- -----------------""- -.------ ----- ------- ----------- -------- ---------- ------ ---------------- FINAL INSPECTION BY:.___��-�------r-------------.---------------- Date------------ ----=`-"------•0--------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT , 1601 E.Hazelton Ave. 300 West Oak Street 124.Sycarnore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS V REVISED 5-59 301 3-'63 F.F.CC.