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FOR-OFFICE USE; ----------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. I ------------------------ - - ------ -------------- (Complete--in Duplicate) Date Issued ----- 3 --- ---------- -------;-------------------- L This Permit Expires i Year From Date Issued Applica#ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described This application 's made in com liance with County Ordinance No. 549. 20 7-0,0 0-0 e _ j------P - ------A,4K JOB ADDRESS AjD LOCATIONIhMmxt --- 9 0-Ai Owner's Name _ } Phone----------------------------------- -)--------------------------- - -- e ------ x---------- - i 1 4 ---- 4 6 W---2-------------------------------------------- ----------------- Address---------- ------60f-------6 ......L.........q__L( -------------------STK Contractor's Name--- t5k:-� _o0!7- 4 --------------- --------------------------------- ------------- Phone....._._.----------------------_ JEJ" - Installation will serve: Residence Aarfment House Co Mer pa Trailer Court [] Motel E] Other 1� W 11 Number of living units: 4--, Number of bedrooms Nf b .umber of baths Lot size ----W.. ________________.____ Water Supply: Public system C3 Cornmunity system [I Rrivite [Depth to Water TableZ_9� ff. Character of soil to a depth of 3 feet-3 Sand E] Gravel [] Sandy Loam K Clay Loam El Clay [] NAd6be Hardpan F] Previous Application-Made:, (if yes,date -------- ,No P— New ConstrUCfi on_:.,Y,, 0.0 7 : �'es El FHA/VAr No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q S Sep Vc,lank: Distance from nearest well--S!?------Distance from founclatio....../0------- Material----- X---4K d ::r-----------Capacity_____ No. of compartments---- 2-- ---------------size-- ------ _4�_ -__.Liquicl dept__ Disposal Field: '�fcunclaticn---- ... Distance' to nearest lot line---- Distance from nearest well well-F0_.........Distance from ... �A, Number of lines---------------------------------Length of each'line........70--------- Width of trench..... ---------------- Type of filter material---- ------- -----t-----Depth of filter materiaL.-IY!--------Total length__- ---1-49�_____________________- -E too. See .... to ne"arest lot line__ 7-------- ,P P if: Distance to nearest well-----/,Nz Distance from found� Number of pits----�Z----------- -------------bepth-----25------------ 0. Cesspool: Di.sfance from nearest well-t--------------Distance from foundation"" -_ I J� ----------Lining material-------------------------------------- Size: Diameter Depth---------- ------------ ........... ---LiCapacity----------------------------gals.I El --- ----------------- -- quid Distance.from nearesf'w building-_----___-_-_-_______________-___.._ "--. I---------------------------------------------------Distance from nearest b0ding a -----1% 1 ------- ID Distance to nearest lot line:--- ------------------------------------------------- ------------------------- ---------- Remodeling and/or repairing (describe):-----------I---------------- -------------------------------------------------------I------ _1-------------- ----------------------------------------------------------------------------------I------------------------------------------------------------------------L-777-4------1------------------------------------------ ------------------------------------------------------------------------I----------------- ------------------------ Wow iii'm Wit - -- --- -------------------- ----------- ----------------------------------------------------11------------------------------------------------------------- --- ----------------------------------- --------------------*----------- ----------- ---------------------------------- 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,,7d rules and regulations f th oaquin Local Health District. (Signed)------ -and/or-Co - ---- -- ----------- ----- ------- ----------------------- -(Owner ntractor Title( )--------------- J ------ ------ ----------------------------------------------------------------- --------------------------------------------- --- --- ---- III 7wing _11ocation of system in relation to wells, buildings, etc., can be placed on side). (Plot plan-; sk- ft Ii e I bl� - 4 - ---..--FO.R"DEPARTMENT-USE-ONLY-- APPLICATION ACCEPTED By?`_---r( ---- ------- ----------------------------------------------------------- DATE-------//:77/ ------------------- REVIEWED 'BY------------------------------------ ------------------------ --------------------------------------------- DATE----------------------------------------------------------- BU I LD ING-,PER MI-Twl SS U —------------------------------- 777 Alterato—nsindt/or ------------- --------- -------- ----- C7 ------------------------------ ----- ---- ------------- ---------- -3------------- ---------- --- -------------- - ------ ----------------------------------------- -------------56N jP---------- ---------- --------------------------------------- -- ----- -------------- --------- ---------------------------------------------- ------- - --------------------------------------------------------------------------------------- ----------------------------- ----------------- ..... ------------ - -------------------------------------- ------------------------------------------------- ----------- ---------- ....r:---------------- FINAL INSPECT BY: - ----- ----- ------ Date-------- ...... 5Z SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 0.59 3M 3-163 F.P.ru,