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FOR OFFICE USE:--------------------------------------------------------- - I t APPLICATION FOR SANITATION PERMIT Permit No. . U. ...... _.. ' ----------- -------------------------- (Complete in Duplicate) � ---------------------- This Permit Expires 1 Year From Date Issued Date issued _____K/4111 2� Zso� 3 I Application is hereby made to the San Joaquin Local Health District for a permit to construct and inshall t e work herein described. This application is mad in co liance with County Ordinance,No. 549. Fas eA ��1 _ _.. JOS ADDRESS AND LOCATION--_----- !?W _--_ --I -,/-- ----- R. sr-1-m-ap----------------------------- Owner's Name-------7&_RA.��------- '- -S- -- --------------------- ----- --------------------- -------- ----- - Phone------------------------------------ Address ! 19G)+ I---------------------- -------------------------------------•---•------------------•--------•--•------ Contractor's Namel N_ ---------------------------- ---------=---- ----------------------------------------------- --- -------------- Phone----------------------------------- Installation will serve: Residencl [!r Apartment House ❑ Commercial ❑ Trailer Court ❑ Mtotel El Other E-1Number of living units: -------- Number of bedrooms 3.: Number of baths@ _.__•Lot'size. _--- p x --_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tablego.-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam'Rt-�-�Iay ❑ Adobe ❑ Hardpan C;--- Previous Application Made: (If yes,Idate--------------------) No�ew Consfruc_tion: Yes'[�'INo ❑ FHA/VA: Yes ❑ No [?ff— TYPE OF INSTALLATION zAND SPiECIFICATIONS- r (No septic tank or cesspool permitted if public sewer is-available within 206 feet.) Se tic ank: Distance from nearest well___ _Distant from foundation__._®V_ Mat� ial_-_G_'Q__��_'_1---- ____. N P 1 / W `r. � No. of compartments---1 _!�__-___.__Size__�X)_O> S_Liquid depth-_"/_- —-------Capacity__.___.k_0 o Disposal Field: Distance from nearest well-5- _-...Distance..fromJou'ride'fion--- ---------Distance to nearest lot line____ _____ Number of linesi------- ___ Length oi�'each'•line___=_____ __ t 1 - � _ - -_ _._. _Width of trench--------Z_SL-�` ---------•- � - l t r r Type or filter material__ ._ ©. J{-__Depth of filter rnatenal____-1_ ______-_-_Tofal length__._ ______ --_________ -� �� Seepage Pit: Distance to nearest well._1Q((?______Dstance from foundation----l�_-____.Distance to nearest to line______ _________ Number of pifs-_IP. _r_1-_. ---Lining material__ROG/.�___.Size:•Diarneter X -c?-,_.Depth--.-- _�______________ 7 Cesspool: Distance from nearest well-----------------Distance from foundation__________________Lining material___-_--_---_---------__----------� ❑ Size: Diamefer--- -----¢------- ---------------- Depth:.;' -�l = Liquid Capacity----------------- ---------gals. r` I t°+ i. _ a n t Privy: Distance.from nearest well__________________ _____________ 1- .-Distance from nearest building_.-_-_______.-_______________----.--_. �^` r t O Distance;to nearest Int line - - - ------------------------------------ Remodeling and/or repairing (describe): ------- -----------------------•---- ........ ------- ------------------------t-•----------• ----------------------------------------------------- =-. ---- -----------------_-------. -------------------------------------------------------- ------------------ ------ --------------------------------------- ---------------------------------------- •---------------------------------------------•---•--------------- ------------------------------------------------------ ----- p. I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of t o San Joaquin Local Health District. 1 A [Signed} - -- ---------------------------------- ---------- -----------------.----(Owner --(Ownr and/or Contractor) Y ----------------- - -------------------- ----------------------------- - -----(Title)'_-7 -r --------------------- z T - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). i t 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- t.R.- ------------------------------------------------------------------------- DATE------_j-- �,�"-5-77 7 REVIEWEDBY------------------------------------- ----------------------------------- --- ------ -- --------------------------------- DATE------------------- BUILDING PERMIT ISSUED--------------- --------------------------------- ----- - --------------------------------- DATE-------------------"' Alterations and/or recommendations: ------------------------------------------ - ------------••----------•------------ --------- ---------••------------- 10 /-------------jt-7-7-T_.._----- - _n�_1��-----------�'`_J4,__n------- ----------------------------------------------------------- 1VOT� G ? !Fcc------------`- ---------------------- --- t .� ------° ---•------ ------------------------------- --- ------ - -------------------------------------- /l} - s Date . FINAL INSPECTION ------ - -- � � - -- -------- -- --- a ` `., SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Yw F.P.CO.