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FOR OFFICE USE: __._._._.___ ------------ -------------------- _ _.___•__ APPLICATION FOR SANITATION PERMIT Permit No. 2111.!J�f - -- - - - ------------- (Complete in Duplicate) Date Issued J1�52�i4z ------------------_ --.- 1--- -_ -----.--- This Permit Expires 1 Year From Date Issued � z Application is hereby made to the San Joaquin Local Health District for a permit to const' ct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 1 JOB ADDRESS AND L_OCATION._,O.Z ---------- Owner's Name------- /r�� l _I__ a� - Phone rf' Address-----------------t � ---- � � �,---------------------------------------------------------- ---- ------------ Contractor's Name------... --------------------------------------- Phone_ �c Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __. Number of bedrooms _-�Z. Number of baths -------- Lot size -----. Water Supply: Public syst 'Ty sy e pth to Water Table ...._..- ft. f Character of soft to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobev Hardpan Previous Application Made: (If yes,date_-----__-----._- ) No E] New Construction: Yes ❑ No [:] FHA/VA: Yes [:] No F-1 TYPE OF INSTALLATION"AI $ (No septic tank or cesspool,-p�#fiQ if I sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundatio ___.._._.._-__---. Material.------....__..-------------------.-------.._. v ❑ ,�j%J , No. of compartments-- -------- -------Size ------------- - -----------L,�id depth-------- --- -------Capacity...... ------ - 67 Disposal Field: Distance from nearest well _ 5.... .Distance from foundatiore 7-----.._....Distance to nearest lot line_ ?.�—..._. Number of lines .._.._. ___. Length of each line_-:__. ?....-..-._...Width of trench .... -- ..._ -,blek 1 a3-- Type of filter maf'�tr --- 'q4 �_CHth'of filter material -- -`�-----Total length--------- _/`?`r-------------- Seepage Pit: Distance to nearest well 1-05_+------Distance from fo ndation /-5+_-.Distance to nearest lot line...?--.5------- Number of pts- c __Lining material _. _Siz iameter-__3-, f/ p 'l Cesspool: Distance from nearest well -------.--------Distance from foundatrw, ........ .. .. ...Lining material-------------- --------------------- Size: Diameter--- --------------- ---------------i'Depth_.._.--_.__-._..__..-.-,--- '------------------Liquid Capacity— gals. Privy: Distance from nearest well--.. _ ------------------Distce from nearest building . ------------. .__.._._..... -... ❑ Distance to nearest lot line - --- --- - --------------------------------- - -------------------------------------------- Remodeling -- ---- - ..-- - ----- -Remodeling and/or repairing,(describe •----- .___.eet_ -0'77-- ;----•---.____ __..__ . ---_k __-_- _ ... --- 1 6464fur y that I have prepare t is application and that the w k will be done in , or, ge; it 5 d q ounty ordinances,J e w nd rules _ d regulations of the San Joaquin Local eal (Signed) ,- - - - -- -` - - --------- - aro ✓flr Cotitractor) By:--------- - ------------ ----- -t-------- -------------------------- - '�----(Title)-- ....... --- ---- -- (Plot plan, showing size of to ocation of's) �q it relation to wells, buildings, etc., c be placed,)Pn reverse side). F p PARTMENT USE ONLY APPLICATION ACCEPTED B DRAT -9�/ --------------------------------- 4REVIEWED BY-------------------------- - D E---- BUILDING PERMIT ISSUED------i----------- ------------------------------------------------------ -----. D - - ---------------------- - Altions ------- -- ---- ------------------------ - - --------------- ------------------------------------ V ,« ---------------------------------------------------------- .-.:... 4 r}, FINAL INSPECTION BY: ,_ :'' ---•---------- -------------- - Date.: 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 F.P.C C.