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FOR OFFICE USE: ----------- p `---- --- ------------- ._� "-" APPLICATION FOR SANITATION PERMIT Permit No. ._ 7 °" -- -------------- ------ „a.. (Complefe.in Duplicate) ZO - . .� .. -'-Date Issued __�l___.__..___-� ---------------------� _. __."_--.__.__ _-_ This Permit Expires i 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 described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OC TION----------8-(9,5---------- 1 ' --------------- -------------------•-----•---------------- • i Owner's Name-------- 'Phoney 'r�' ''" = -- ----•--------------------------------•-•------------------------ --------------------•------------- Address----------------- --_---- .. Contractor's Name:-------- , ----------------------------------------- ----- --------------------------- Phone.m 19 -------- l Installation will serve: Residence's Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-/---- Numl?er.of bedrooms -___:�i9Number'of baths-_I----- Lot size -----f --#F...__X_-/ '.___---____________--.._._ . ,- Water Supply: Public-system 0 Community system ❑ private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date.-"-.------"-.._..-_) NoK New Construction: Yes*o' No ❑ FHA/VA: Yes ❑ No,9 TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank'or cesspool permitted,if-public sewer is-available within 200 feet.) t Y Septic Tank: Distance from nearest wefl_ �2 ;._Distance from foundation----- -e` No. of compartments------�-------------Size----- -"'_ S_ -Z__"_-Liquid depth----Z' C-------------:Capaci#Y--: Qf'_ � Disposal Field: Distance from nearest well' f- Distance from foundation___ ___r.._'}__._Distance to nearest lot line____`.._.. Number of lines----- ------•�-------------"""_--Length of each line-------Z.0--'_------- ---.Wid#h of trench_._.__ _5!''_- --_-:-----.-- Type of filter material' :_ .-.'Depth of filter.material-._._fes'_---------Total,.length_ _-_____---' r� r r Seepage Pit: Distance to neafesfwell__��r-----rDistance from foundation-__"`S__"--1"___.Distance to nearest lot line__-...."-.. 0()�! "A Number of pits-------{_I-----------Lining material' ___ ` __ _-Size: Diameter---------- Depth-- ---j-------------- O Cesspool: Distance from nearest well--------------- Distance from foundation---___________-1..._.Lining material-------------------------------------- Size: .-_____- ,______"_-_.--.-_--"-_-_--.Size: Diameter-------- ------------- ---------------Depth-------------"---'-------------------- --------- ---Liquid Capacity-------------------- -------gals. �Q x ___"______________"-Distance from nearest buildingv i Privy: Distance from nearest well-----------=----=------------ s --_ ---------------------------:--._------�- ,1 ❑ Distance to nearest lot line------•---_. e - ------------------------------------ =------- -------- fr 1 Remo eling and/oz repairing (describe:__.____"_ .- �Q = �c=�.:'"�F H'� �} r `- �'�- '�`r •�' �_� - ` --`-------- 5_-61 :�[___ . ,ryyyr�Lte�L t eta-•_ .ter, - rt �,,c y!y c 3 -------•------•------------------------------------------=-••---•------------ ------------------------------------------------------------------ ------------------------•-----------------------`--------------------------------------------------------------------------------------------------:------- 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'ihe' San Joaquin Local Health District. F .• A1.4 - O Mner and/or Contractor e [Signed)-------••- •-` �.-•--- �«-��-f.------------- -•••.•-----------------==------- -------------------------•-=---- { � � BY•• yl �cr� —--------------------------------------------------(Title)-- ---. ... (Plot plan, showing size of lot, location,c system in relation to wells, buildings, etc., can be placed on reverse side), k � # FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED.BY---- -- -f' - • / -------- ---- i ------- DATE-----!'---- -- --��- -�-- ----' REVIEWEDBY-------•---I------------------------ ---------------- ----------- -------- ------ DATE'�----------------------_-------------I---------------- ING PERMIT ISSUED---------------------------n--------------------' _ DATET. = Alterations and/or r@commendations:"_.`._-.v_I! ._^•(,----_'_./f __.___-__ �=`��s C---- � �r 777,-_t-- pe -6 ------------ -------------------------------- --•- -------- ----------------•--------------------------- l�k FINAL INSPECTION BY: /! _f------ -------( �----- Date . ---- --- ------------------------------------ AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVl3EG 13-F9 3M 3-'63 F.P.CC.