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FTOFFICE USE: d -3---- ------------ . _________________Cr -- / APPLICATION FOR SANITATION PERMIT Permit No. .. �oQ.-__7 /-- ------ ---------------------- --- -- /.---- ..(Complete in Duplicate) 9 / ----�°---- -- -- Date Issued -----_��6 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 No549 I :. JOB ADDRESS AND LOCATION_.--9A6LOD 6 (�4 ---------- ----------------------- --------.-------• - : Owner's Name-------•->��---� --• .. '. - --- ------------------------------•------------------ -------------- - - ----------------- ---------------- -------- Phone------------------------------------ Address-----•-- �r� ------------------------------------------------ Contractor's Name--------- --------------------------------- Phone.... will serve: SResidence ®1Apartment House ❑, 'Commercial ❑ Trailer Court Q ';Motel ❑ Other ❑- I Number of living units: _: __,Number of bedroomst.:F__ Number*of•.baths /... Lot size . F --------------•------------•------- Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table A9 ft, a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ,Adobe Hardpan ❑ Previous Application Made: (If yes,ldote------ --------- ---._) No New Construction: Yes [g/Igo�cl❑ FHA/VA: Yes gj-- No ❑ TYPE-OF INSTALLATIOWAND SPECIFICATIONS: ,(No septic tank or cesspool permitted if puEc sewer is available within 200 feet.) i Septic Tank: Distance from nearest well----"'_^'_ ---Distance from foundation �Q ___.Material--- �__ Ly N No, of compartments--- "� ---- -------- -- Li uid de th-- - ' Disposal Field: Distance from nearest well "' Distance from foundation_Ap�_�--Distance'to nearest lot line._�71____. Number of lines�_a _______�__ ____ _ Length of each line, ---__Width of trench-.'.�f_______________________ Type of filter mate G' �--Depfh,of filter.matenal� Total length___./��P_ Seepage it: Distance to nearest well____ -~- -----Distance from foundation---A00-------.Distance to nearest lot line-0: �__- 4 Number'of pits-- ___________-Lining material. ----Size: Diameter. ------------- Depth +- Cesspool: Distance from nearest.well-________________Distance from foundation__-_-----_-._-__.._..Lining material--------------------- _________ .. ❑ S" : Diameter------------------------------------_Depth_-------------------- ----------J- - -------------Liquid Capacity------------------------ •gals. N Priv Distance from nearest well------------- ___________________________________Distance from nearest building_-___---_______--________ Privy: Fi Distance to nearest lot line = - ------ -------------------- Remodeling and/or repairing (describe):----------_- _ _•--- N ------------ � ---- -- ----------------- -- P, --------------------------__-------------------------------------------------------------- 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. (Signed)---------- f �� . . C ------------- _ --------------- _- _ - -- `"� BY:-------------------K--------••------------------•---------------- , •�.an /or Contract r -- ------(Title)- ------- y { ) �' ".------ -------- --------- (Plot plan, showing size of Iot,.lo�afion of syste in relation to wells, buildings, etc.*can be placed on reverse side). 6 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------A �� ------------------- ---------- DATE---------- REVIEWED BY -• - ��f = - -------------------- ------------------=-------------- ------- DATE_:-------------I-- ---••- --------------------------- ----.�,.. BUILDING PERMIT ISSUED-------------7 _ DA•TE---------------- Alterations and/or recommendations:-- - -- / .. ___N C -�--- - ----- -- ------------ ---------------------------------------- -------------•----- `7~ ------"y --- -- --------- ------------ --------------- ----- --- -- ----- _ ------ y---------c" r •----•---- ----------------------------------'........---------I-----------ur---y----.-.---`- ------------------------- ..�� - ---- ------------ o' ---------�f -----------!31 �-��+�IA i�•,�`�. � - �„`'p1 � `lf�C.E?i't'i M'�►�i� � C.'"'+rc.K t� .f[.?.a,[r� -'�1 i�� `�i.G. '�� FINAL INSPECTION By.- ------ __._--____ Date__;.._ . - y - -------- .--+ ----------------=------- N J0�4 LO AZ HI�)�ISTI� '. t w 1601 E.Hazelton Ave. 7_-G-9 300 West Oak Street 124 Sycamore Street L . (C.. p —lf.y Z 205 West 9th Street Stockton,California Manteca,California ,�7racy Caornia F , Cali ES 9 REVISED a-59 3M 3-'63 F.P.CD. �Y` 0+ �+W. �N,, V {