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FOR OFFICE USE: _ �.. -------------------------------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._..t?..;;L-7L - ------------------------------------------------------- (Complete in Duplicate) � .. Date issued _. ------------- This Permit Expires 1 Year From Date_Issued , - -: Application is hereby made to the Sar Jaquin Local Health District for a permit to construct and nstall:the work herein described. This application is made in compliance`with County Ordinance No. 549. � ' A�rr i JOB ADDRESS AND LO TION__1.11— 51 A�-��--W�,.:J.j�D � �i x-- �'ll-- RR_dL��!�1... ------ Owner's Name------------------ -------C ��1----------------------------------------------- ------� Phone-------------------- ------------- Address---------------RT ------•-----Address---------------RT ------ -------•---R)_8Ve4J----------------------------------- _..._..- ---------------------------------------- Contractor's Name---- � 6 --------•-••----------------------------• ------------------------------------------ ------ ----- Phone-----------••---------------------- Installation will serve: Residence [i�<Apartment~House E] Commercial ❑ Trailer Court ❑ 4eil❑ Other Number of living units: _ _ Number of bedrooms ---I_._ Number of baths ---j--- Lot size ---- ---------------------- Water Supply: Public system ❑ Community system ❑ Privateer Depth to Water Table 3$1t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay"❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dateu--------------- -) No 'New ConsTruction: Yes W4--f�o ]f 4HA/VA:-Ye,-fl -No,2 '— TYPE -TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic n Distance from nearest well-- -------Dista e frim foundation:}__��--__---.Ma eriak- QN_r,Ft 2277 Pl�ar{►k No. of compartments------/2_.-- -------------Size, x__Jx-,�...-----Liquid depth__._.. ��.----Capacity_ a--_-- p 1�_.......Distance,to nearest lot line_____. Dis osal/Field: Distance from nearest well.__...._Distance from foundation.._ _ _ Number of lines---------- ,Length of each line------- �..__-----Width-oi trench..-_---3-D' T e of filter material-- , C _ r �� t -- -------- --•♦- yp .-_,Depth of filter materiaL.___��__,______,Total alength_}.________�'.��_'_____________________ � Number of its.rest_'_.__ ss Distance from foundation--!______________:-.Di;tance to nearest lot line_-----------_-_-- Seepage Pit: Distanceltuber to nearestwella 'Lining mat erial-_=�_� ---- -_....Size: Diamefer..............Y:.---_.Depth_---------_--.._---_-.-_-_.---_.- Cesspool: Distance from nearest well---------------IDistance from foundation---------------.....Lining material-------------------------------------- El -.--___-----__----- -__-_.❑ Size: Diameter--------- -------- ------- ----- Depth-----------------I----------- - ---------_-_--Liquid Capacity-------------------------....gals Privy: Distance from nearest well-__-----.--....I- ---------------------------- Distance from nearest building,�_.______.________.____,�._:.-.-.--._.-. * �.._ ,. r ❑ Distance tz5'neares#'lot lin---------------------------------------------/--- r ---------- Remodelin and/or repairingN � ST v1ft- c- ------------------------Q---- ------ - - - -- I _ __ _ I hereby certify that I have prepared this application and tha}the works will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) _ - - --------- _ _ {Owner and/or Contractor] ---- -----------------------------------------Title ------------ -------------- ----- -------------- L.— - ----------. (Plot plan, showin siz o lot, location system in relation to wells, buildings, etc., can be placed on reverse side). 4: FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY----T~i.-> "�1-- ----- ---------------------------------------- DATE-------- --- / --1��_. REVIEWEDBY------- ------------------------ ------------------------------------------------------ -------------------------------------- DATE-------------------------- ------------------- BUILDING ------ - BUiLDING PERMIT ISSUED-,--.:.v.— -- - _ --------- DATE - ---- .- -------------- Altera#ionsand or recommendationC Q_ -------------------------------------------------------------------------------- ------------------------------------------------- ---------------- q _ - -� __ FINAL INSPECT 9b Date----17-___z7_-.13r SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.ffaxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California '" Manteca,California Tracy,California I E5 9 REVISED 5-59 3M 3-'63 F.P.CO.