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---"-- ----FOR OFFICE USE: ----- ------------------ ----------------------- ------------ ---------- ---------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._I-_ -------------------------------------:-----------------__ (Complete in Duplicate) Z ----------------- - --------_-------_- -----------------------__------- ._._ This Permit Expires 1 Year From Date Issued issued Date Application ishermade to the San Joaquin,Local Health.District for a permit to construuct and install the work herein described. This applicatiori is made in compliance with County-Ordinance No. 549. JOB ADDRE S AND LOCATION-------�9-�1-------- _�t"� _ B -----•-�A1��•---- -�--OT�-----� �----•----•L��H.�D� = - - - Owner's Name-----=- ------------ Q- - " .�" "- '----....----14 Phone------------------------------------- ------------------------ f Address. 1 --- •---M---------- --------------•---------------------------------------------------------------....... 1 Contractor's Name -!1�_ ! --•-----•----"----------- •-------------------------"---------------.--- ---------•- Phone Installation will serve: Residence B' Apartment House ❑ Commercial ❑ Trader CLI71 ❑ Motel ❑ Other ❑ "Fidiiib>� /00 x I C7 C� I Number of living units: __�_____ . umber of bedroom;_ Number of baths l_.aLot size ....®®__________________._.._________.__.-______________._._ Water Supply Public system Community system ❑ Private ❑ Depth to Water Table _ s? . ft. Character of soil to a depth of 3 feet: Sand eGravel ❑ Sandy Loam E]. Clay Loam p Clay ❑ Adobe ❑ Hardpan ❑ Previous Application,Made:_41f�yes,date._ -_1 :No New-Con str.uction.:_Yes,.0___ro-P-.- FHA/VA: Yes-,�Ido ❑ TYPE OF INSTALLATION:I�AND.SPECIFICATIONS: !4 r:'► -- t _�(No.septic fa k,orcesspool•permittedci#_publictsewer_is±ov_al,lable;-within 200 fee z . Septic Tank:,. Distance'from nearest well_;` `Distanca'fromfoundatlopn_�1� "" M terial �/)G} -----T-------. t-. o? R Nb. of compartments-____--• _ �----------5ize3X_J_QX--�--_----Liquid depth y -------_-- _-. C;p664__40_0_0-_-- V �� f Disposal Fie! 1?istce from nearest weld d 1/' Distance from foundation______ _j__�1_-_-r0istance to neo�esf lot line___________��__- Number'of lines__________ Length of each line1F0-%5'27'2! Width of trench__ ._______ I t , T pe of filter material Q_C! --Depth of filter maferial___�g �� ._Total length__ --loss_'__________________ Seepage Pit,: Distance to nearest well � ..___Distance from foundation _-_ �___ --.Distance to nealpsf�lot lane_________________ ❑� N6 'ber of pits.................... Lining material._--- ----------------Size: Diameter -------Dept ------ ------ ]{ -n J 1 Cesspool- Distance from nearest well_________________Distance from foundation_--__._____ ______.Lining. material___.._ ____ --.-________._________. ElSize: Diameter------------ -----------------------Depth--------- --- ---------------------------- -----Liquid Capa ity--------��------------------gals. .. rom-nearest building Privy: Distance from nearest well------------------------• ,•-••- -----------.._Distancef9----=------------------•----------------- [� Distance to nearest lot line------------- - --- -------------- ----------------- ------------------------------ is Remodelin and or re airin describe : �.l __.�i FQI _ 7Ft ,_:��-1=-- r1N_D l �N S-_ /0---- �----'. �.__,-----------�lR_�_•lb-.,r.artlf ��--- �---_-- --- ------------------------------- - is - = " f i3 1 31 # ... -------- ------------------"•-•-•------------------------ ------ - ------ -------------=------- ---------------------------- ---------------------------------------------'=, ` : t -...- f fl I herebylcertify#hat�l�h ve 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'i5an Joaquln'L'acal H &-Ith'District. (Signed)--------- ------ --------- -- ------------------------- {Owner and/or Contractor) sY /r"2._".` G� -----(Title)------------------------------------ -- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ^' � yt �. FOR DEPARTMENT USE.ONLY, Al IAPPLICATION ACCEPTED BY---- Rs--0 ------ ------- ------- - ------------ DATE------ ' REVIEWEDJBY----------------------------------------------------------------------------------------------------------------------------- DATE----------------=------------------------------------------- v . BUILDING-PERMIT-ISSUED-- _ .. - =__- _— . ._,_-T� ------------------------------------------------------ T "-- - - _ Alterations acid/or rrecommendations`,xi___________ ____ _ �� V�'� �' ~ # VA_► �+ r = ----"-•------------------------------------------ ------------ - ------------ ---------------•--- ------•--- -------------------- ---- t 1 ---------------------•--------------------------------- -----------------•--------------------- -------------------------------------- ----------------------------------------------------- I k -----•---------------- -------•------ t F - , FINAL lNSPECTI N BY: Date. - --------- SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Hazellon Ave. 300 west oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Cs 9 REVISED 8-59 3M 3-'63 F.P.CD. -