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r FOR OFFICE USE: ------------------=------------------------------------- ;. -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ../.7� - ----------------- ---------- ------------- ---- ---- --: (Complefe,in Duplicate). I - � ,..�.� Date issued - --- - This Permit Expires 1 _US7r Frbm 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. 549. I PON W al AEII JOB ADDRESSFAND LOCATION= N.-T- ;= PR1_ _ 'js' ........ parq----- Owner's Name - �__f --------------------------------------------------- ----------- AddressT �dIJ------------------------------ F --------- E Contractor's Name L.E�-----� --- )-G - ---------- I--------------------------I -------------k............�Ph_o =* .... Installation will serve: ,Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 151 Other ❑ . r Number of living units: _ �._- Number of'bedrooms 3)NumgDepfh baths Lot size ______ ---- GR �� --.__-__ t ?' „�Water-Supply . Public ystem ❑ Community"system -D—Private to Water Table l�ft. ? _12- I Character of soil to a depth of-3-fee+.—Sand Gravel-❑-Sa' y Loam E] Clay Loam ❑ Clay E] Adobe ❑ Hardpan C3Previo s Application-Made., (If New Construction: Yes 9;�'N'0 ❑ FHA/VA: Yes Zr""No E] ' `TYPE;OF-'"INSIALzLATION•AND- � - -� 51'ECIFlCATIONS: (No septic tank or cesspool permitted if public sewer is ,available within 200 feet.) Septic k: Distance from nearest we�5-P_ _Dista ce�frcirnX foun-daton_ _ -�_-_____.Maten—al___ ��_�_ �� .-_.—. �V+ /yQ ---- Li uid depth � -Z --------Capacity-- LIZ��- No. of compartments------ - ------ - •Sine m 9 pis osal Feld: Distance from nearest ell.... ____.Distanc� o ouJ�dation__':_,IQ-"_____. istance to nearest lot li e___.�___.____. t p Number of lines--------: ¢ __Len th'/oeclirS _ idth of trench------ , __ See a Pit: Dissnce'to�nearest well____..._C..___ *Distanc�e�froer materiaL______��_ ..___Total length__.___"�'7�_-_ _�1fJ_._ Type of filter material-__ Q__-�__De th f^filt p ge m foundation------------`_------.Distance to nearest lot line_________________ ❑ Number � p - ------� _,� 9,� �. - -----._.n tion------------------ Linin materia-----------------------------•----- P. Cesspools Distance "from snearest well_-Linin �Distanl, .____ _ Size: Diameter-_____________________Depth ce from foundation g - ala. ` Priv Distance from nearest well epth "' � ' � ______Liquid Capacity___________________________g Z ❑ Size: Diamter________•____-- D y ---------- -------------- Distance from nearest building .!Z k eares� lot line` -`---------------------- •------------------- i ❑ , },tDistante to,n Remodelingand/or:repairing (describe)----- -------------------------------- -•------ ------•------ --- -------------------------------------------------------- V,t '= .....................r_.t =- -�------- ------------------------------------------------------------------ �.' - - --------------------------------------------------------------- -------------- ----------------------------------•----------------------- ---------- hereb cern that I have re orad this application-- - - ----------------- -- - ------------ ---------------- I -- - - Yh W10— ordinances, State laws, and rules and 'regulationf the San Joaquin Local kHealtheDistr to accordance with San Joaquin County District. . d J .(Signed) = -- ---- --- - (Owner and/or Contractor) y By:---------------------------- ---------•---------------- ----- "--------------- -- ----=-- ---------------------(Title)---------- ----- --- - ------ - ---- (Piot plan, showing size of Iot,.loca+ion of.sys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �7 APPLICATION ACCEPTED BY----- �_ -' - ---------------------------------------- DATE----------7--2- REVIEWEDBY------------------------------------------------------------ --------------- -------------------------------------- DATE-------- ----------•---------------------------- ------ BUILDING*RER-MIT-ISSUED---:-- ----- -. ----------------- DATE--------- -r Alterationsand/or recommendations:--------------------------------------------- -----------•------- -------------- -------------•----------- ------------------- -----•-------------------=-------------------- ------------------------------------------------------------------------------------------------------ ----------------•-----------•----------------------------------•-- ------------=--------------------------------------------- ------------------ - ---------------------•----------------- --- ------ ----------------- -_ ---- ---- ------- - -•------------------- -------------•-•--------------------------------- ----- ---------------.---- FINAL INSPEC .1/ [' Date `' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California .•, fi ES 9 REVISER 5-59 3M 3-'63 F.P.C4. � � l