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FOROFFICE USE: „ f--------------------- ------ ---------------------------- { ' APPLICATION FOR SANITATION PERMIT Permit No. ....... ........ (Complete in Duplicate) � Date issued ---__-•--�-�---�� ,___D I f1i <---nl . > 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 Ordinance No k549. 7 r �g�_07"Pq N-P S OB ADD ESS AND LOCATION - - = ��= 1,�T�' ----�f �.KJ L_T..5!� Owner's Nameli7�.� _ � == o(ilT. - ��` f�Hhone--------••---------- 'i9�1C 1 }fl�' — sx- Address � �------'.--.--I�. � �. '� Contractor's Name--MAV_I__�_- ------!6tF-1TMrn--._- ------- ------------------------------------ ---- Phone----------------------------------- Installation will serve: Residence A2`_Apartment House ❑ C Yercial El Trailer Court 11 Motel [❑ Other ❑ Number of living units: I------- Number of'bedrooms ----- Number of baths /---- Lot size __ - C __ r--------------- -- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table/fit. ' Characterof-,soil.to a depth of 3 feet: Sand IK Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application' (If yes date.- ] ,No New Construction: Yes.pg- No ❑ . FHA/VA: Yes No - � 0 -- -- 1 51 TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permittedrif,public.sewer.ts-.available within-200 feet.) Septic Tank: Distance from nearest 0- ---Distance from foundation.__1 _-____-_.Material-- ��-r� .�--------. No. of compartments.....�--__--_____Size-.�M�.�ty-�'.Liquidt,depth------- --------- -------Capacity--- 5✓4�____�R-�. Disposal Field: Distance from nearest well_50-----Distant/ frM%found f•io'nl-- _-V--------.Distance to nearest lot I ne--�. Number of lines--- -_-- -----------------Length of each line----_- �____-_--.Width of trench --- - -- �- t n fi nearest we ,_____-_-`___-_�Dis ante from foundation---_-R---_---.__.Distance to nearest line----------------- � Type of filter matenal;_ �:---- .__Depth of filter material----�_ - _ �f Total length---------- ------------------- �, O Seepage Pit: Nis a Number o s -------Size: Diameter----------------------_De th_.________--------------.----._1 ❑ Number of pits.----------�----±�Lining material---------------- € p N" �, ,,,r. .- ._...r - - ._...,j I Cesspool: Distance from nearest well �""""Distance from foundation--------------------Lining material--._.__-----__----.--.-------------- ❑ Size: Dia ------------=.....Depth---------'------------------------------------------ Liquid Capacity---------------------------.gals. Privy: Distance from nearest well----.---__I------------------------1..-------.-Distance from nearest building------------------------------------------ I ❑ Distance to nearest lot.1 line---------)----------------- --------------------------- --------------------------------------------------------------------- k Remodeling and/or rering�(describe�- ---- ---- --- ------------------ - •----------------------•----------------- ------------------------------------ ------------- ;i +C ------- F ` ---------------------- ------------------------------ --------------- -- ----------------------------------------------------------------- -- ------ ----------------------------- ---------.------------ -- -.. = - _ rre+ ---•---------------------------------- ti ---------------------- I,hereby ertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordd,innances, State laws,l and rules and regulations of he San Joaquin'Local Health District. (Signed)-. =a - -•------ ---` -------------- ---- - --: ----------------------= _-----------------(Owner-.and/or Contractor)- y• -t, . ----- ---------- ;,------------------------------ 13 • : - (Plot plan, showing size.-of lot, cotton of sys+emj.in relation to wells,,buildings, etc., can be placed on reverse side). ■ �FOII"04kfMEN2SE-ONLY APPLICATION ACCEPTED BY-------. _A-------------------------------- �" �`� DA-TE� �� >�=q; .." �;------ REVI,EWED BY---------"' --------------------------- .......... ----- - - ---------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPCRMIT ISSUED----------------------------------------'"= k----------------------------=----------------._ DATE-- --------------------------- ---------------------------- c { F Alterations a'nd/or recommendations:--------- t------------------------ ' - ----------------------•----•------------------------------------------ Ilk t +• --•----••------------------- 'A --.- -. - - ' ---•---------------- -------------------- -------------------------------------- -- ---- -------------- �71 ------------------------- - ------- - - ----- --�---- ----•-- ----- N- •--------- -------------------------- ,ri �itr.�t�k - - j FINAL INSPC�1'T�P16 ^. ---- ------- -- ' 1Fe - Date ._ do '�. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lotti,California Manteca,California Trac Stockton,California Y.California ES 9 REVIFEo a-59 3M 3-'63 F.F.CC.