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'FORCrFFICE USE: ------------------------------ --------------------------- z. ---------- ---------------- -- ---------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. ....... ---------------------- -- ---------- -------------- (Complete.in Duplicate) ------------� Date Issued ------------------------------------ -- This Permit Expires 1 Year From. Date Issued' Application is hereby made to the San Joaquin Local Health District fora permifjo-consfrucf-and install the work herein described. application with County __T�ls �plicafion is made incompliance Ordinance No. 549. 'y JOB ADDRESS 1� 'ANk�k0CAT'1ON_YyV_y--------/2L 2-00149------ ------69 1 --------------- -W PIZZT�----14//---/--------------- Owner's Name—---------- ----------------- --- ------------------------------- Phone---'--------------------------------- Address--------------- -_------i3 ax-------lf2l.17----- AIA_NT-F—_-C!4 Contractor's Name------ -------------/------------= ------------------------- -------------------------------- Phone----------___------------------ Installation will serve: Residence JB' Apartment House E] ,Commercial E] 'Tr:ailer, Courf El Motel El Other ❑ Number of living units: Number,of bedrooms .�� Number of both Lot size ......7;77---N--- fI - . ------------------- - Water Supply; Public'sysfem ❑ Commznity system E] Private [Depth t alter Table ft. Character of soil to a depth of 3 feet: Sand-Gravel Lj Sandy Loam Ej " Clay Loam [:] Clay E] Adobe 0 Hardpan 0 Previous Application Made: (if ygls�clate------- ------------) No Now Construction I ..Yes 0--No Ej FHA/VA: Yes ❑ No W . 6 TYPE OF SPECIFICATIONS: (No septic-faink or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank, '-D�stance from nearest well----,S is.anc on- .Mat —------ D' t from foundafr; a 0r 0" ------ - compartments------11:- --------.--Size---- A No. of.'�' ---7X5 iquid,,deplth-----P�__'Capacity----1P(9(!2__ Disposal Field: Distance from Distance from foundaiti&5-1./a, Distance to nearest lot line--- - 4T7;7_ Number of lines-__---- -- ---------- Lengtl�' 84each Width of trench-_ -------------- Type.of filter Depth�o_f_SjteLmateri,61__, .1 _-_-Total length--_--_--- -- rj��tTWAII"_. -----Distance from to nearest�lotllline_`.- ---------- I Distance fo-�nea foundation 7nW _ Seepage Pit: fo,, Number';fi,pits�_�_--r., �t --- Lining material------ - - --------Size:.Diameter-- ---- ----D—epfh_-7`1 7 Cesspool- .-Diifance from nearest well_ -Distance from fo:cindotion—-------Lining,ma-terial-------- ---------------------- ❑ Size-:'Diameter---- -----------------------------:---Depth------------------------------------,-----------._Li quid Capacity-------------- . .....gals. Privy: Distance from-nearest well---- ------------ ------ -------- D is faii' f ro-_('h-4�2 A' banding- ------- El -------- �I Ir " .: ------------------------- Distance to nearest lot line--- --------------------- - ------------------------ ----------- ---------------- -------------------- ---------- Remodeling and/orArbpairirg.(closcqb- ------------------------------------------- ----------------r------------- ----------- 7 ------------ -------------------- ......--------------------------- --------------------------------:-------_----------------I --------------- ------------ ------------------------------------------------------ .. ------------------- ---------------- --------- -------------------------I--- ........ -------------------------------------------------------------------------------------- --------------------------•-------- ----------------------------- ----------- ------------------- --------------------------------------------------------- =---`---------------------- -----—-------------------------------------------:------------ ---------------------- ----------- I hereby certify that I have 6rApared this application and that the work will be done in accordance with San Joaquin County ordinances, State- laws-, and rule I9r ' egul ons. of the San Joaquin Local Health District. ,c _----------------- ------------ --------------------- --------------------------------------- -----(Owner and/or Contractor) By:---------------------------------- -------- ------------------------------------ ----------- -----------------------------------------(Title)------------------------------------------- ---- -------------- (Plot plan, showing size of lot, location' of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONUY%_A-14114 -T.:lie i APPLICATION ACCEPTED BY--- �-}�- 1 1-�-��--`•-•--•---- ---- ----------- ---------------------------------------- DATE-------- 2- REVIEWED BY------------------------ ---------------------- ---------------------------------------------------------------------------------------- DATE------------------ -PERMIT ISSUED-----------------------=------------- ---------- ---•--------------------------------------. DATE Alterations and/orr FMme 7 dations:...... ------------------------ ---------------------------- - --------------------- ------- rn� -------------------------------- ----------- f 7 21 N K------- I --------------- ---- - ------ ------1196� --------------- APP k_ I--------- 1-R-n- N_>------In.....I --------------- ---------------- --- ra --- FINAL INSPEC Y. Date .--------- w SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED E3-59 31A 3-'63 F.P,Ca.