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FOR OFFICE USE: -- ------ ---------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..-ice$-r --.-- ---- ----- --------. J _ (Complete-in Duplicate) Date Issued .------- � _-- _ This.Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local'Healfh District for a permit to construct an*install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION yk 1 Phoftb_--- 7777=-------------- Owner s Namer. Address----f L 7 ... c f ------------ - - -- ----------- ------ Contractor's Name----- 9W_tg6-R--------- Installation =---- - F l? �iQi313J_NS Pho . .. ; ---------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [�� Number of living units: -- ----- Number of bedrooms -1--- Number of baths .}j Lot size ----- Co ------------------- f , Water Supply: Public system ❑ mmunity system ❑ Private -Depth to Water Table eft Character of soil toga depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay',Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application- Made: (If yes,date_.--_-._.-.__---- 1 No �ew Construction:!Yes{� No ❑ FHA/VA: Yes ❑ No 2" TYPE OF INSTALLATION AND SPECIFICATIONS-_- i No septic tank or�cesspbol permitted if sewer is available within200-feet.) - -- T ( P Septic T nk: Distance from nearest well-_.S-!�?------Distance from foundation.....45-._..... Material -- - ----------_---------------____________ ----- Size -b - ------Liquid depth-- 5� . Capacity---1'� No. of compartments_-__..._�- j � �-- ---------------- - Disposal Distance from nearest "jell---..TS..�_---Distance from'.1oundation-_�Q_....._--Distance to nearest lot lin�_� Number of lines -----------(---------------------Length,of_each'line-- ------� ---7_t---Width of trench:.-------z�_-__.-p__-------- s, Type of filter material_ GK._-,:Depth-'bf filter material------J.�r_.........Total length--- ;Z_______. .�--------------- VC, Seepage it: Distance to nearest well-_1.Q-49.......Distance from foundation___IQ..___--- -Distanc to nearest lot iine�._ - Number of its. Linin material,R40 -_ Size: Diameter. X._V_- Depth----.. p ! g Cesspool: Distance from nearest well ----------------Distance from foundation--------------- -.Lining material--:--__---.---._----------__----._._. ❑ Size: Diameter- -- -------------- - x-.Depth_•-------- ----------Liquid Capacity -------gals. Privy: Distance from nearest weEl------------ ____ _______---------------.....Distance from nearest building------------------------------.-...___._. I ❑ Distance to nearest lot line --------- -- -------------------- -------------------------------1-�------ "----------------------- Remodeling and/or repairing (descr;ba):---------- - ;rCrS- / 't�1C-�..� --- -•-----------------------------------•------------ --- -------------------------------------------------- --- --------------- - ti -------------------- -------'W----------- ------------------•-----------------------W-------------------------------------------------------------------_ --------------------- I hereby certify that I have prepared this application and that the,,work will be done in accordance with.'San Joaquin County ordinances, State aws, and rzuls. aRre9tions of the San Joaquin Local Health District. -- -- -----------(Owner and/or Contractor) - ---------------------[Signed)By:----- -- ------------------------- --- -_{•" ► ---- --- ---------------= - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on..reverse side). FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY_ --------- -------------- DATE------ ----------- ____.-_-�1.�--�----- ----�------�---- -- -- �- REVIEWEDBY----------------------------------------- -- --- ----------------- --- -------------- -------------- ----------------------- DATE---------- ----•-------- --------------------•--------- BUILDINGPERMIT ISSUED------- -------------=----------------------- ---------- DATE------ ------ `---..-.--------------------- Alterations and/or recommendations'-_--_-- _-. - -. ----- - .. - - ---- - -- ------ !%'- :w: :::r �. _..h :z -^--fib`--A-------- -ro L4[HT 1 Mond_-:DhV�4"1—) � _";`� ��'l1�LK: "�'. _.T31* �/��TAt�.a? ca----_ g _. - i� . R 'i--.-111 . . - �Y - pT'� . - T�_.R__0-. 44 Date.......... FINAL INSP. �---------- /-i9!6 I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street r 20,5 West 9th Street Stockton,California Lodi California = Mcnteca,California Tracy,California E.H,9 2M 1.67 Vanguard Press 1� .