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OR FFICE USE: 4 71 APPLICATION FOR SANITATION PERMIT Permit No. ..1.__.7 .;7-�� ------------- ----- -------=----------------- [Complete in Dupiicafe) " _ . . Date Issued ___.-y__�--___-- f ------------------------------------------ --------- This Permit Expires 1 Year. From Date Issued f Application is hereby ma12le.to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made Nn compliance with County QOrdinance No. 5499.. r [' JOB ADDRESS AND LOCATION _-y-�:!_- --------- r v '---------•- ®'�F �"r'----------------------------------------------•--- r P1 Ji -9 2 Owner's NameL__,?e -- kL e---�•O--�----------------"- Phone "T :/._J- I F Address '' ------------_------------------r k Contractor's Name-------- --------------• oLi_ /_ __ Phone.._-... _ .V .- Installation will serve: Residence [/'Apartment House ❑. Commercial ❑ Trailer Court ❑ ?Motel P Other ❑ Number of livin units: __�___ Number of bedrooms}' -Number of baths ___I"__ Lot asize_-__/._ _ ___ _ _1__r�-6--------------- Water Supply: Public system W_Community system ❑ Private ❑ Depth to Water Table _v_ f W Character of soil-to a depth of 3 feet: ; Sand;❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe Hardpan ❑ I I el Previous Application Made: (If yes,date.....-. ............) No 0••-�-Neri Construction: Yes �o E] FHA/VA: Yes ❑ No TYPE 6 INSTALLATION AND SPECIFICATIONS: { (No septic tank or cesspool permi}ted if public sewer is available within 200 feet.) ` ji ` Septic Tank: Distance from nearest;well ___._______ Distan e fro forund��ayytipn__-� ----------Matoriai------________�_�C__S_______.__-____- No. of compartments_____�D� Size_ __ _7__Liquid depth----------- -----------:Capacity.._ �Q al Field: Distance from nearest well_____.-."____.-. ! (ff [ Dispos Distance from foundation.."fL!_._ -Distance to nearest lot line_S_.__.___.. l Number of lines______ ___ ___.___- Length of each line_ .112_C160). _ -_-.Width of trench-____,�.______l --_____--__U -Type of filter matenal ' _ _.P_@ _Depth of filter.materia___-__. g r # Total length � � p g i______ __ _______ Distance from fo ndation__. U__...___.D ante to nearest lot line______.____?_---_ c� See a e.Pit: Distance to P Barest elf- Lining material -IAB Size: Diameter-------35.."-.---Depth_.____G:<.a? -----------� Number of its_._.__ ,Cesspool: Distance Pram riearest ❑ well______`-------- Distance from foundation--------------------Lining material---.------.------.________:i., Size: Diameter- I------------------------q - De th--------- ----------_ - -------------_Liquid Capacity ----------------- • ----�-gals. I zf Privy .Distance from nearest '_-------------------------------Distance from .nearest building------------------------------------------- L ❑ e - _..r c i Distanceto nearest lot line - -�----------------- ---------3--------------------------I----------------------------------------------------------- ----- Remo �Remodeling and/or repa�ring[.(describe)-:- --- .--------------- ------------------------- } ' � -----------------•------------------- ------------•-------------------•------------ ------------------... 9 , _________---�-'_ � S _ _______________________________________ ---------- ---------- __--__.- -__-_____�_______________________________________•___----------------------- ____-__-_______________-_ ___---_____---._________-________________ ( . 1 ___ ------------------------------------ s�__.._.___ -________ --------------t ___ F ---------------------------- - ' i.- � 1 "_" 'r --- t -------- -----------�-= ------------------------------------__J------------•--------------------- -- - ---"-��-- --"- I 'h ereby certify that I have prepared this application and that the work will be done in accordance with�a'n"J'oaquip County ordinances, State k State�`.�laws, and rues' u ifions of'fhe Sla.iy oa quin Loacal Health.Dist ric't. ----------- � Ownerad/o Contractor.(Signd -----! -- - -------- B - --- By - -------------------------------- ----- ----- (Title) ------ ----- - - ---------------- -------------- -------------------------- --- (Plot plan, showing size.of-lot -location of,sys+em to relaftotn.ta wRells,_buddings,. etc., can,be..placed,on-reverse,side).�...,,, . s FOR DEPARTMENT USE ONLY 77 APPLICATION ACCEPTED BY---------- ------------- -- -------------------- -- ------- - _L�< DATE------------- REVIEWEDBY-------------------------- ----------__--- -------- ------- DATE----------------------- ----------------------------------- DPERMIT � DATE Alteramation - � r -s3_' �' � - -------- ----------------•----------------------------------------------------------- ------ ------------------------------------- - ----- -------- ---- I ------- ----- --------- -------- ------------ ------- ----- - ?�► FINAL INSPECTION BY:-------- -'-- -'�r.�t------------------- ------------ Date--------------1 ,_-a'-�.~--f�-'--/-----.-- -- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.fla:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3-'63 F,14413-