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FUROFFICE USE: —.... --------------------------------------------------------- --------------- ---------------- ---- / APPLICATION POR SANITATION PERMIT Permit No. ,(. (Complete in Duplicate) j This Permit Ex fres 1 Year From Date Issued / --- ------ --------------------- -- -- Date issued 2-• --•6 Sc Application is hereby made to the San Joaquin Local Health District for a permit to construct and inst Il the work h� described. / This application is made in compliance with County Ordinance No. 549. I� , , OwBeADDRESS AND L, TION_ : - --------- rf' c.-.r� ��` fes✓ c: t t - ____________ f r �� s Name_ L� .... P ;'�'-7- .__ P Address % � II ne =: �_ = - --- --------- Contractor's Name____ � , ,�4� . ` - ' {_..__._ '� -------- --------- ---��-------•-------•------------- one------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailelr Court ❑ Motel ❑ Other Number of livingunits: _ e Number of bedrooms Number baths , lfr�d - Lot size = f�------------------ ----------- Water Supply: Publics stem IM y ❑ Community system ❑ Private Depth to Wa4 er Table ________ ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy'Loani ❑ Clay 'Loam ❑ Clay bet] Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ! `� (N epfic tank or cesspool permitted if public sewer is available within 200 feet.) r Septi ank: Distance from nearest well ___5.7_4�r------Distan- from foundation__ IP __ f --- Materia! ---� _ - No. of compartments �' ! --------- p ---- `----- Size-- --. . Ca pacify- j.�'frC�_ Of r - ._Liquid�dep�th- -------- P Y------ Dispos field: Distance from nearest well-__ C1Distance from foundation----- ! ----_ -_-Distance to nearest,-lot line_:________.. Number of lines________,, Length of each line_______._ ` —I - �= r� .Width of trench--- -------1 4 TType of filter material_ ----- p s De th of filter material______- g- -_____Total length-___:�-aL-'�C Seepa .e Pit; Distance to nearest well"`-d _Q__ Distance fr m oundation1:f'__-.___ Distance to nearest lot iine___ ��_,.__-_ I Number of pits_____ Lining material___ _ __ _ Size: Diameter________ p ' Cesspool: Distance from nearest,well_________-___--_Distance' from foundation- ----- ------------ material__--_-____-- ❑ --------- i Size: Diameter__°-----------j----------------------Depth---------------------------- =� Liquid Capacity gals. / r ` 1 f -- ! Privy: Distance from nearest welL________________--_._____---_____-_-_____-_____Distance from nearest building +O i Distance to nearest lot line_______________________ .� rI�•------- Remodeling and/or repairing..(describe): _- ____.------ i -�-.:_ - ------------------- -----------------------------------------------•---------- 1 --------------•-----i ---- -- - ------------------------- ------------------------------------ ----- - _ I- ----------------- ----------------------------------------------------------------------r............................................ . ..... I hereby certify that I have prepared this application and 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. (Signed 1 o actor) BY:--------- --- �.. •----� ` ;'; C I _ ��' —----------------II(Title) ---------------- ' - "_ (Plot plan, showing size of lot, location of sys+em_ira_relation..to wells,{buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY_--__-- _ _ ------- -------------------- ------- I� DATE- = A _ :=`' ----------------------- REVIEWEDBY ------------------------------------------------------------------ ----------------------------- -�------��----��-- DATE------------------------- 4 UILDING PERMIT I55lfED. - -- _-------•---- --------" ------4----fir DATE Alterations and/or recommendations:----------------------------------------------------- -• _ - 11 ------------•-------••..-•-----••------- -�- -1.. - --------------- - ------------------------------------------ ----------- ---------- ------------ ------ - ----------------------------------- --`----------------------- -------------------- I +I ------------------------------------ -------------------------------------------- --------------------------------------- - FINAL INSPECTION BY:..- - -------------- Date_------i------ r-K -. SAN JOAQUIN LOCAL HEALTH DISTRICT, 1601 E.Haxellon Ave. 300 West Oak Street1ycamore;Tree) 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California t ' ES 9 REVIS EO 8-59 3m 3-•63 F.P.p p. + 1 � r .t.