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FOR OFFICE USE -------------------=--------------------- APPLICATION FOR SANITATION PERMIT Permit No. ......-X........... (Complete in Duplicate) ' -------------------- - _ ' . � Date issued 1 ..---------____________ _______ ____._ 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 instal] the work herein described. This application is made in compliance with County Ordinance No. 549. -' bS'i—(W--Z2 UPOP - Sr—) ls� rr JOB ADDRESS AND LOCATION COP --------P_ 1' j -,IST l� C- - —------�0 �I---�._... . Owner's Name-----L-,0-I (F-t4---------- 1 Address P.� -L="-'OC_-C--�Q��7----------------------------------------------------------...... -- Contractor's Name---- = l`�--------- 1 r------------• ------•------- -----------------------..._--_. ----------------- Phone-:��_�_.9.�?.Q_7__ Installation`will:tserve: Residence �jApartment House ElCommercial ElTrailer Court ElMotel ❑ Other L].4T �i — Number of living units: A---- Number of bedrooms _3._ Number of baths _`L: Lot size -------- ___---etC-*2-�______________________ Water Supply: Public_system [I Community system_❑ Private&/ Depth to Water Table _-i�b7ft. i Character of soil to a depth of 3 feet: Sand E] Gravel ElSandy Loam E] Clay Loam Clay ElAdobe❑ Hardpan ❑� Previous Application Made: (If yes,date-----------7------ 1 No New Construction: Yes E] No FHA/VA: Yes F1 No 'TYPE' F fIV ALLAfION-AN SPECIFICATIONS: �t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 p1 � Septic Tank: Distance from nearest well-___-_.________-Distance from foundation--------------------Material------.------------------------------_____.__._. ❑ y; Ir,�4 No. of compartments---------- -----------Size. ---------------------------Liquid depth----------•--•------------Capacity----------------------- Disposal ---------------------Disposal Field' ' DlBtance from nearest well-_---- ---_-__Distance from foundation--------------------Distance to nearest lot line------_______-.. ❑ Ij-rn 6 Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------------------------- Type of filter material------------------------=Depth of filter material-----------------------Total length---------------____________-__--------------- Seepage Pit:Pit: Distance to nearest well-�A&V-)'-__--Distance from foundafion__•.. a____._..Distance to nearest lot line____.4_-___....- Afl_D Number of pits------1�________Lining materl-_fS: . G LSize: Diameter-__-__ _"-----Depth_____________ ___ Cesspool: Distance from nearest well-----_........___Distance from.foundation------------- ----- Lining material--------------------------I-_-__------ r �-, L�-Ii...4 ., El Size: Diameter-------- ------------- ------------Depth----------- -- - ---------------------------------Liquid Capacity----------------------------gals. Privy:. Distance from nearest_well ___j._ _ ---------------------------- _Distance from nearest;building____________________________--______ or Distance to nearest lot' ne ---------------------------- -- ----- ----------------------------------------------------- Remodeling and/or repairing (describerGC - - _/S / n_7 . -------------- r' SLyi''` ' ` -•-------•-------- f , f -- I ,# :I = ----------------------•---------------------------------------------------------------------------------------- -------------- ----- _______________________________________________________________________________j__---_-__---_-_-_________-.----_-_---_-_----____,______________________.__________._____.__.____________- ____-� _-________ y hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin{County 1 ordinances, State laws, and rules and regulations,of the San Joaquin Local Health District. Si ned eh f`_ '_! -0!1- - --------� 1v __:__--. (Own r and/or Con+raetorl BY= •-�. ate-=- ( ) �� -'C -.... (Plot plan, showing size of lot, location of,system,irt,relatio4f to,wells,,buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY ---------------------------------. `'i _ DATE_fq_'/3_'. -- -----f- ------ REVIEWEDBY-------------------------- --------------I - -------------------------------- ------------------------------------------ --- DATE--------------------- ------------------ BUILDING PERMIT ISSUED '- D..FA TE Alterations and/or recommendations / r� ~ - 41.I Z/ - �� ... 2 •-------------•--------------- -------- -•---------------------------- 1 --------------------------------------------------=--•--------------•-----_------------------------•-------------------------•---------- -------------------------------------•--•----•--------------------------------------- -` = _ ).. -------------------------------------------------------------------------------------- --------------------------------- - - FINAL INSPECTION BY..-------- ------• -=------------ Date -------------- k I �.kCA9 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lo/ydi�,California 1 Man1tse-IM,�Calif�orniia,J/� �_ //Q / Tracy,Caliiffolrni. Kfi 9 REVISED 8-59 3M 3-'63 F.PSC C. /{ / ;. 1 // /.,r/7 � �//f✓~A/'�"�I{//J r .(�II/AL�/ �4t- ��(�f //_k_,'/'vp/•`.a`JA,/�C fIl !/// 7d•-`� "`Y•�y`r"""III r✓�