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FOR OFFICE USE: f/r --------------- :_ Q APPLICATION FOR SANITATION PERMIT Permit No. .__,l.h.:_ .. ---------j° b`'-4-40 -- -- --++ (Complete in Duplicate) �i l_ Date Issued ....!- ��- 43 ------------------------------------ --- --------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. a -------------------------------------------------------------------- JOB ADDRESS AND L CATION------ ---------------- Owner's Name------AvIle....;Qo. +Yf- - •-•------------•-•------------------------------------------------------- --•--- Phone.................................... Address- ---- -------------------------------------------------------------------------------•--••------------------------------.._.. Contractor's Name------------ ' ... . . --•-••--•--••-•---------. ------•••... Phone---------------------------------- Installation will serve: Residence �rApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E] Number of livin g units: ._.9_ Number of bedrooms -48" Number of baths J-__ Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .&1-4--, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No U?,' New Construction: Yes ❑ Not[ '''FHA/VA: Yes ❑ No K- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T,ank:+ Distance from nearest well_________________Distance from foundation--------------------Material-----------------------------------.--_.________- , G�]l► 5�� No. of compartments--------------------------Size................................Liquid depth-------- ----------------.Capacity---------- �1 Disposal Field: Distance from nearest well-._!""."'�.._Distance from foundation...1Q__.........Distance to nearest lot line.4 .f.____. Number of lines________ __________ Length of each line___/W,6? -- ------ 9 -01------------Width of trench--oZ--------------------------- 6 �• Type of filter material f--Depth of filter material__ -----Total length..�t4 ..-_._•_________________ Seepage Pit: Distance to nearest well-----" -P------Distance from foundation---s2AP__.-_-.Distanceto nearest _ Number of pits -._/_____-_-- __Lining material__�� ..Size: Diameter- �----.___Depth-._ ___sf_-_________________ CeTsp Distance from nearest well-----------------Distance from foundation---.----------------Lining material------------------------------------- Y ❑ Size: Diameter------------------ -----•------------Depth-------------------------- ----•--------•-----------Liquid Capacity----------------------------gals 00. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-___-__-._.__.___.___-•_-__---.___-___.-. ❑ Distance to nearest lot line---------- --------------------- --------------------------------------------------------------------------------------------------------- ? Remodeling and/or repairing (describe)------------ ------------•--•---•------------------•-----------------------.- .....................................---•-------------------------------------------------------•--•-------------•------------ --------------•-------------•------------------------------------------- ---------•----------------•-----------•-----------------••-------------------------------•-----------------------------------------------------------------------•------------•------------------•--------•------------------- -----------------------------•----------------------------••---•-•-------------------•----------•-----•----------------------•---------•--•-•------------------------------•-----------.-•-----.---------------------------- 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 —/or Contractor) By:-----•-•-•-----------•-------•-----•---------------------------------- ------------(Title)- i&e,---------------- -- ---- -------- (Plot plan, showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ' Lj � ------------------------------------------ DATE--- REVIEWEDBY------------------------------------------------------------ - ------------------------------------------------------ DATE-------------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------- ----•• --------«------------------------------------v--- DATE•-- J--- -------9-- ---- ....... Alterations and/or recommendations:__ ___.._,F ZZ _� __: -� -�, .�_ ra. :___.__,�_ �`--------- ..... ............... ------------•---r-------------------------------- ----------------------- - / , A --------------- - --- - --c�—�C- 6 t z s2 c �'4� =G2 e ...................... ------------------------- -------------- ---------- ------ FINAL INSPECTION BY:. � ------------- Date------,�Q----� ---- ................. fSANJOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. estOak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD.