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FOR QFFICE USE: _ ---------- --------- ---------- ----------------- ------------------------ ------------------------ ------------------_-_______-_----------------__-_-__-_----.-.- APPLICATION FOR SANITATION PERMIT Permit No. ..1 .... 4VII "` r .(Complete in Duplicate) Date Issued .l ---_fes__-_-----------------__- .------------ ------------- - This" Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install-the work herein describediA This application is made in compliance wiWCounty Ordinance No. 549. =,a CA,ix \j JOB ADDRESS AND LO T Oft . . 1 ---kj#464------ Owners Name---------------- ----------------- - ------ Phone-----•------ -----=------------•--- Address---------------t/ --- .� W-1_>- - k 4- E.-- - ----- --------------------------------------------- ---•--------- + . Contractor's NameT-C-A------isitt-b � f .' --•--- Phone----------------------------------- a. Installation will serve: 'Residence E] Apartment House E] Com ❑ Trailer Court ❑ Motel ❑ Other Number of living units �.-._16 Number of bedrooms _ .- NuIM I mber of aths �� Lot size ___ �- 1C --------------------- Water Supply: Public system ❑ Community,system ❑ Private VDepth to Water Table -------- ft. Character of soil to a depth of 3`feet: Sand Gravel Sand Loam Clay Loam Clay -Adobe HardpA t. Ili ❑ Y ❑ Y ❑ Y ❑ ❑ Previous Application Made: .(If ye ------- J No New Construction: Yes &" o E] FHA/VA: Yes ~No TYPE.OF INSTALLATION AND SPECIFICATIONS:,, (No septic tank or cesspool permitted if,publlc sewer is available within 200 feet) i P Septic T Distance from nearest well Distance from foundation.---.L� .. _.Material � No. of compartments_._ . .---Size-%`� -1-49--X-55---Liquid depth. CapaciitY�!Jzo Disposal Field: Distance from nearest well -- -Distanc!from foundation nearest#lotgline. ...�--.� Number of lines--------- -----------Length ofeach line __ i� _ '`.Width of trench _.. -- Type.of filtertmateriaL- -Depth of4ilter material --�_17 1----Total` length------ _-.`---I-DQ a Seepage Pit: Distance to nearest well F __Distance from foundation -_� _--Dis ante t9 nearest lot line_. .---...- Number of pits._.-.1 _.___ --Lining mater•5171310'P- 'Size"Diameter_ .-JI(_; __.Depth_--__4W---"--...._ ...�-~ 10VVN $r A0SZ t ) • t/„ I t Distance. from nearest well' §.----.-....Distance from foundation :Linin material_ - ----------------------------- A d► r+ +� f �. g Size: Diameter;°t; ___. +* j-- __--.Depth ` ' *04 Liqui4d,`Capacity- _ _.. ............gals. f, e I r4 Privy:. Distance'frorri nearest well( - ----------- --Distance ------------------------------ _ -------- V, Remodeling and/or repairing (describe):._._.. ( ) > 3 ---------- -- ------------- --- ....... --- -------------------- --- --` ---------------------------- �• I hereby certify that I have prepared thts application and that the�Work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulationslof-the San Joaquin Local Health District. (Signed) --- -- --- G �� ------------------------------ - ------ -----------------------` ,.-----(Owner and/or.Contractor) k ��'• , BY�--- -- �.-•�Y"�%� --- -- =`�--�-•-�--��` - ��-- - ----------------------- --------- ----- -(Title)------------------------------ --.---- -__. . .--- (Plot plan, showing.size of�lot,elo.catL of's ±ern in relation to wells, buildings, etc., can be placed on reverse side). e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -1 .J1---or-- ---------- -- -- --------- ---- ------- -- - -- DATE --- - -- -------- REVIEWEDBY-------------------------------------------------------------------------------------- ----.. DATE----------- . ----------- BUILDING.PERMIT,;ISSUED--- ---- -- DATE ----- ---- Alterations and/or recommendations. ------------------------------------ -- -------_._- -_- ------- -------------------------- (� ' _... . t1dl i/ '>`x� '�� ------- = ------- ---------------------------------------------- HA R_QM ..',?-bNbj.7 - ------------------------------ j�-UF�►� — i�`` .�-Lr �=tQ�h--- '-----------------`,1t --�� ------ ---------------------------------------------- ----------- -------------- ------- FINAL INSPEG710N BY:.. _ � '�.:-._--_ -. Date....-------- . _—---- _ -.h ------------------------------- SAN ..-- -__..___SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD.