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FOft OFFICE USE: ------------------------ 0----------- --------- Permit No. .... -_____--_--_-___ _ . " "- ___.--------------------- ------------------- _-__----_--_---_ APPLICATION FOR SANITATION PERMIT I ------------- -----1.---------------------------------- (Complete in Duplicate) 6 --_-._"._-_-____...__._-___- ----------------- This Permit Expires 1 Year From Date Issued Date Issued ------ ___�_____________ Application is hereby made to the San Joagwn-?Local Health District for a permit to construct and install the work herein described. This application is made in compliance with`Couri*y drdmaAce:Nil. x549. JOB ADDRESS AND LO ATION -1 p-� -•A _ iUr4 ------- ---"M. � - C == y --- ---- fl C�1/0,� Phone 3�2 Owner's Name__________________�. VX _-..�. n Address _.._.' .F-1 AL-AM_�,P,� -------- A..T ------------------------•--------•-----------•---- � Contractor's Name_t ?l pae------•---•------------••--•-----•- Installation will serve: Residen a Apartment House ❑ ommei c64 _, ,atle- Court ❑ Mo'1e ] Other ❑ j� Number of living units: �__`_ Number of bedrooms - Number of baths __��Lot size ------.A�:C_ "�-:---------------------"_--- Water Supply: Public system ❑ Community system j��ivate ❑ Depth to Water Table ..: _ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay -dobe C] Hardpan ❑ Previous Application Made: (If yes,date__._-_ -_.-._-_._.) No fiction: Yes &P-1go❑ fFHA�/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cess ool permitted If public sewer is available within;200 feet _ ( P _� P P - Septic jawk. Distance from nearest well-----------------Distance from founddtion ........ .....Material. _. --_."_-_______ _--______._._.___-. 5 AJ 6- No. of compartments,____ _ . _. Size................ ......... Llquic depth _ _._Capacity._..._—._________ Disposal Field: Distance from nearest well... -------Distance from found boy.... V-2—.Distance to nearest lot line_,*.`. Length of each line_ ��"'E Al Number of lines__ _.---- _ f• �`Width of ench----------------- i r X Type of fuerater �l..f 1'�._Depth of'filter material_ ,Total long ---------- ----------- --------- Seepage ______Seepage Pit: Distance to nearest ell_ _-__--___"___Distance from foundAtion ___ ._ ::Dis#�t4 nearest lot line_________________ ❑ Number of pits_. _- .._..__-_ Lining material--------------04:-___.S(ze Dimeter..._._. )Depth ____________________ _ ---------- T Cesspool: Distance from nea t well___"--_______ .._Distance from �ound ition_ !�o " 1fiYing ma rial------------------------------------- 0 _ . "_-_"_--___-_____.-_________❑ Size: Diameter------ - - - -----------------------Depth --- Liquid CaacitY gals. Privy: Distance from nearest well____________ ______ .______--_._ ___ __-------Di tance Frmfor is test build) f -----------------------------_----------- ____ ____ _____ ------- ------------------------------------- r ❑ Distance to nearest lot line...__._ ___-:_ - q Remodelingand/or repairing (describe)::.__,5��T /�_ -"__I.�-5) -.. ��R_L_ G Q V IRI` v A!_S PFTI_t? -.,._e_ _ /V - -4T.��}-----tr P CRs N-----------H--F------ A I S--- M n�u. .. :rn -� ear- -.._._ . . --------------- �Q ` l - ------ -- T t - > r ----_ `/}- D------1 - - ---- q y I hereby certify that I have prepared this application and that the work will be;done in acc rdance with San Joaquin Count 1 ordinances, Sta s, and rules and re ations of the San Joaquin Local alth Biatrtt:P' '" (Signed)------- �------- iL R (Owner and/or Contractor) By:---------- ------------------•- ....... -•-""•----------- ---- -------- t ------- ------------(Title)-- -- -- ----- -- ---- - (Plot plan, showing size of lot, location of system in relation to wells, buildings; etc., can be placed on reverse side FOR DEPARTMENT USE O LY r APPLICATION ACCEPTED BY.------�f� _-'-----------------------x------------------ -.. ----------- DATE------------ ?.__-- _ ---23------------ REVIEWEDBY ---------------------------------------------- --- - ----- -----------•-- DATE---------------------------- ------t ---- ---- BUILDINGPERMIT ISSUED-------------------------------------------------------------- ----------- DATE--------------------------------------- ------_-------- Alterations and/010 recommendations:-.-.----------------------------------------..... ------------- ..u� ---------------- "--------- _ _: ...... ... . ...------- --•-- ----- a FINAL INSPECTION BY:------ ------------------------------------ ------ -- Date--------- 7=1177_6-3 SAN JOAQUIN LOCAL HEALTH DISTRICT 16011.N=*11"Ave.. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California KG 9"REVISED 8-59.3M 9-'63 F.P.DO.