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�OR OFFICE USE: ------------------------ ------------- - APPLICATION FOR SANITATION PERMIT Permit NO. ------------------------ - P Duplicate) 112-0 ---..-__.______.__--------------------- ----------------- � This Permit Expires 1 Year Date Issued /�I �PZoa ?-�` t I - 1 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. yV1 STI^tRA_ JOB ADDRESS AND LOCA710N...1� - � �-------------- -------------------------- -------------------- Owner's :`a .. Owner's Name--------- ------ P- .. Ir— - _� _U- _ ------ ------ --------------- ------------------------------ --1"I�� �--1" ` ------' . 1 U Address_ �.�� -�---- --��_r �� -------��/�-----. ��+�"-�i��---C�'__Phone ---•--------•-------------- �- r••� � Contractor s Name_-----_!__i__#'�..------- �............... ,.. ��nsatalla�ion�will serve: Residence ❑ Apartment House ❑ �Co�me tial D��'Trailer"Court� Motel C] Other CQther [�]�� Number of living units: -------- Number of bedrooms __--- *.Number of baths �JLot size ----_-. 5_____ �`:..__ Water Supply: Public system ❑ Community'system ❑=�: r+vete �Depf�h to Water�Table f t. Ji, , Character of soil to a depth of 3 feet: Sand E] Gravel ❑Sandy Loam El Clay Loam L3 Clay E]T Adob,le❑ Hardpan ❑ Previous Application,Made: {1f es,date...........:.... ...} No New Construction: Yes V1 5 No E3 FHA/VA: Yes ❑ No ❑r —_ TYPE OF INSTALLATION AND SPECIFICATIONS: l € (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well 1qP---_Distance from found tion----I------------Ma Material--- -- � .--------. 0 --- " ----- z No. of compartments------ � _ -_ X_.- :=--Liquid depth--. --- Capi l - - Size- - - _.��---------Distance to nearesacity.. ..---_-- _-- from e from on "---'-.-.Width Disposal Field: Number-of lines well-10 fl_ _.De�tath of each line ati)p0.Y, Width of t lot lin�l..__�.� � ❑ ` 9 � ,-------------- 1 _ _De th of filter material.---.L_ -_ Total length__-.--- 00____________ ________ Type of filter materi --_`- p ---------- Seepage Pit: Distance to nearest well----------------------Distance from foundation......................Distance to nearest lot line.•..----_-----.-_ ❑ Number of pits-----------------------Lining material-----------------------Size: Diameter------------------------Depth�r --------•---•----------- Cesspool: Distance from nearest well----------------'Distance from foundation-----.--------------Lining material_--.!,r -------------------------------- 0 Size: Diameter--------•------------------- ---------De th----------------------------------------------------Li Liquid Capacity ........gals. Privy:: Distance from nearest well-------------- ----------------------------------Distance from nearest building--------- ----_-_--_---.--. -----------. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------•-••----•-----------------------•----- IN p� Remodeling and/or repairing (describe)----------------------------------------------------------------------------------------------------------------•----------------------------------------- ------------- N 'P Q I _ _ _ _I __ I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 'I . - II (Signed)- ---------- --------------------------•-------------------------------------------------------(Owner end/or Contractor) -------- ------ - - - — - 77 BY:------------•--- ---------------------------------------------------------------------------------------------------•------.-.(Title)- -s------------•-----_-------•-------------- ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse si,i de). �7FOR DEPARTMENT USE ONLY �� r APPLICATION ACCEPTED BY---- -------------------------- ---------------------------------------- DATE-------�.`:LS 1 _1 ------------------------ REVIEWEDBY------------------------------------------------------------------------------------•----_-----.-------------------------.--- DATE................--------------..--.......---...--- ------ BUILDING PERMIT ISSUED -•-•------------•------- DATE R� - Alterafionsand'/'or recommendations--- ------------------------------------------ ----------------•-•-----------------------------...----•-----......----------•-ji-----------••-------•---•------- --1 ------------------------I------------•------------------------------------------------------------------------- -------••-- •-------------------------------------------------------------- --•---•--------------------- ------.-k -1 —. _ :. .T, _ V V - _ ------------ ---------------------- -------•---------------------------------------------------------- ,0- Date--. FINAL INSPECTION B ----------� _ __..- I i - --------- l SAN JOAQU N� ICAL HEALTH DISTRICT !I � M 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West Stir Slreot Stockton,California Lodi,California Manteca,California Tracy California EH-9 REVISED 9-59 P.P.CD,2M 6-ED ' .- �r -- n