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"FOR OFFICE USE: -21/,-� S,J17 r _--__--___.___________________ _________ _____________ APPLICATION FOR SANITATION PERMIT Permit No. .7�. ...._..... ----------------- ----------------- --------------------- (Complete in Duplicate) 1 Date Issued This Permit Expires 1 Year From Date Issued � '- Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. p� AlITi� JOB ADZ)RUBAND LOC TIA 6N T' --k--. 19_Ct-)--------- ._P Ac ------� _1Tz. _0,,rA.N.P-Ems------------- Owner's Name------------- L --•---- AcmeSN------------- -- ---- ------- Address---------------I�-2~ _.. �� L 71_:__ ..- 1 TCA -- --------------------------------------------- Contractor's Name811`IN_T-roc A,, _�_ ��-�TLL.-��_ ------------------------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Traile Court ❑ Mintel ❑ Other ❑ Number of living units: __ Number of bedrooms �_� `_ # Number of baths I -_ Lot size ----Oa__- -__l 5`©__r---------------------- Water Supply: Public system ❑ Community system [] IlPrivate Depth to Water Table vit __ _ ft. 71 Character of soil to a depth of 3 feet. Sand 9! Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [-] Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---- ----------------) No New Construction: Yes Vj"No ❑ FHA/VA: Yes l� No ❑ TYPE OF INSTALLATION AND SP15clkATIONS: �Q r (No septic tank or cesspool peir'mitted if public sewer,is available within 200 feet.) - —--�� 1 1 50 1 1 Septic Tank: Distance from nearest well-----------------Distance from foundation-----f terial_-------------- CO C_) _ .r�.._____- No. of compartments.-------�------------Size---. - - -X Liquid depth-- -----------------------Capacity---9Q 0------- i I 1 � Disposal Field: Distance from nearest well SQ__--Dista� 1nce from foundation---- 0---------Distance to nearest lot line___-S__-_..... Number of lines_1----.----------------_Length of each line__�0. -So-.Sv-_._.Width of trench-.-__236_f tr /----------------- Type of filter material*RQ. C,�.Depth of filter material—L-7--__ _ _Total length-------/-/V----_--_____._-.---__- _ __.__-Distance from"foundation____________________Distance to nearest lot line___.__..._.----- Seepage Pit: Distance to ne'�rest well_______________ ❑ Number of pits.--�- ----------Lining materill--_al__ �` ---.- ----Size: Diameter-----------------------Depth--- --------------- r Cesspool: Distance from neo est --------------Distance from foundation--------------------Lining material _._---_---__--------___.------._.-.. ❑ Size: Diameter- -I------I------��--------------D//epth-------------- `--------------- ------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well'---------------f/__--_------------.-.--_- -\Distance from nearest building-_____..______-________-__--_.._----_..._. ❑ Distance to nearest lot line---------------- ---------- y.� i It Remodeling and/or repairing (describe)-.---- -. ------------ -------------------------^ ------------------------------------------------------------------------ P I -- � ,Yrs .� ,.� ------------------------------------ � - --------------------------- ------------------------------------------- I hereby certify that I have prepared this application,ard that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District: k (Signed ------!J` -- ----7------ --------------------------------- ----�-----------.----(Owner and/or Contractor) ---•-----------•- -•--• --------------..............--------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - DATE,.--// ,2--3--- ,= ----- ----------------- REVIEWEDBY--------------------------------------------- ---------------------------------------------------------------- --._.- DATE-------- BUILDING PERMIT ISSUED------------------------------- --------- ----------------------- DATE------------------------- ----- `' Alterations and/or recommendations:--_--_--_- --_-.-.--------- -------------------------"'-----,#-A-:_a--_____ r % 11 1 R. -A -------- --- .. --_ i s ----•--ti----- -------------------------- , 11 ------------ n..,._..a.�.._ w._-- -.s...-..___ - ----------------------------------------------------------•-•----•--------- --------------------------------------------- ---- -- ------ -------- - ---------------*-------------------------------------------------- FINAL INSPEC71 $ Date ---------=.Y'-- —-- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 0.59 3M 3•'63 F.P.CO. - /L