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FOR OFFICE USE: ---------"------------------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._..1...rZ_�S..C`_ -------------------------- ` (Complete in Duplicate) Date Issued .._...... •.-•�- V- -- -- -- --- -- ------------ _ _____ _ _ _ _______________ This Permit Exaires 1 Year From Date Issued to construct and install the work herein described.Application is hereby made to the San Joaquin Local Health District for a permit This application is made in compliance with County Ordinance No. 549 JOB ADDRESS AND LOCA I N._.. . I��1_I&.. � - ---------------•------------------------ Phone.................................... Owner's Name---------- Edd,l-�---••---------------•---------- ---------------- 4 --•- Address----- 6-or2.� Q.�, L��.r Contractor's Name---- r 7 ,Sts.r?.5.-_ !ter!......................................... Phon Apartment House ❑ Commercial F1 Trailer Court [I Motel ❑ Other F_1Installation will serve: Residence A -.___ Number of bedrooms _ .___. Number of baths __. Lot size _ Number of living units: ...�-------!�C! Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table 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 New Construction: YesV No ❑ FHA/VA: Yes ❑ N>?f TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ^4 , �_.-_Distance from foundation---ZO-------- Material....s7.X.G~l�G��----------------• Se is Tank: Distance from nearest well4v _ Cap tyAwCOO--i,*1 No. of compartments------3._-------------Size. �t-.---Liquid depth__,� 'L--�S'�_'.t'�r_Ca au __Distance fro fo ndation.. W..._. .Distance to est lot I' '�..�•.••-----•—�.�, Dis�o� I Field: Distance from nearest well4�..__ Width of �j Number of lines-------� � �----Length of a-e3 ......... r----- �. !� �./ ___.De th of filter material.___. �.__.___._-Total length------- X.3C1-------- Type of filter material.._ p f Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits----------------------Lining material----- --- -------Size: Diameter-----------------------Depth.-------------------------------- Cesspool' Distance from nearest well-----------------Distance from foundation-----.--------------Lining material,-:--_----_-__--_-_-------•----"als. ❑ Size: Diameter--------------------------------------Depth------•-----------------•---------------------------Liquid Capacity----••-----------------•----9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------- ---------------------------------•-----• ------------------------•---------•------•----------------••---------- Remodeling and/or repairing (describe) ------ .._....--••-------------------- rod��----------- --------- ----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S„t t laws, a,nd rules and ations of the San Joaquin Local Health District. Owner and/or Contractor) (Signed.._ k By:------------------------------------------------------------------------------------------------------- // /P� _ -- - (Title) AOs� (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------- ►-�F--P- =--------------------------------------------•---------------------- DATE 1� y ��E� � REVIEWED BY---------------------------------------------------------- •-•-•----•-------- fif- ............ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------- P-_.�—�_i1%TR.H�7_ !1� -----�.LT ---------- -- DATE------------------------------------------------------------- Alterations and/or recommendations:__c.tf_FCA----C�-�I�Dfa..... T ------7•--Ra-NSPn'�--`-----�--'4!l`,i.t)....... H�T---•----,_ `Tt� T ._]rt1A Gn1 i F�...G' FA ll F_0-------- �-'`� r 42.-•-»--F THN_KS --��--` /So cMA_NG �.Jusr_�:b�_...../_�> c ._.._F 4 K l.ti /�7 r ►� t K E f -� TE7�. 7A r ��f` �— FINAL INSPEC BY: --- - -------- ---------- -- -- -- Date----------------Z__--�---...... 1................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streei* 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California C,—j t::: 1,California Manteca,California Tracy,California Ee•9 REv19ED 9.59 F.P.CD.2M 6.60 r + vvA s //l�S71�t7 e s� R�r _ ;BFjc ;r-_ ►�n%� `�A�C �I U