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FOR OFFICE USE: .r - s -'P, 1 1 tom_ s ------------ -- - APPLICATION FOR SANITATION PERMIT -77777: ------------- t ci (Complete in Duplicate) Date Issue d -------------- - ---------------- ------- ----------------------------------------- --.--- This Permit Expires 1 Year From Date Issued p�'g_ 05-0-3z Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. y .&7,0 A) c,�W. .1 JOB ADDRESS AND LOCATION_---___3--- ----�aJ.J- -- Gv - .-'�=�-------------- �----}----�n0 „ Owner's Name----------i;.) rf /�_�T:�• _ _ _. P --------------------------- Address--•-------••---------- r _. .� 5._.t` _ _ /--� �,��c_7-rz-- l ��_-_f1 o_ hone.._ _ Contractor's Name__________________ __ Other ❑ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court [3 motel E] Number of baths __ -- Lot size ____-- ,iz�/ ----------•----------- Number of living units: __ .- Number of bedrooms _I ,3- ; Water Supply: Public system F-1Communitysystem ❑ Private Depth to Water TableA.`ff�- ft.. $ Clay Loam Clay HCl Adobe❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y No Previous Application Made: [If yes,date____________________I No !4 New Construction: Yes [I 'No EKA/VA: Yes El TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool perrrtitted if public-sewer-is available within 200'ffeeet:]"M •t-- - - i Septic Tank: Distance from nearest well_________________Distance from foundation _______-__;_---__-_.Material_..___.-}__._-_____._._-_____________________-. h .: .. �+ ` ------ .Capacity--------------- No. of;compartments Size-------•--------------.-------=•-Liquid depth-•---i, p Y ❑ k r I \ ' l " ___-Distance to nearest lot line/R�--f Disposal Field: Distance prom nearest well._!-Qp_..._Distance_#rom foundation___1� --- �o 1. �� . Number-of lines--------------- ------- ------'Length of each line____--v2-� rt--------Width of tre#ch___��------- - Type of'filter.•'m aterial____---�/ #� Depth of filter material___ -f------------Total length_= f1-----•-------p--�/� � � 0 f �} �, A 1 Dista to nearest lot line__.!.____.-----XZ Seepage Pit: Distance,.to nearest'well__. t _____Djstance fro foundation �t Depth.- .J 1� - 4_ '� Ize: Diameter.-_---- Number of pits:--.---f------------f-fining material:__:-- -�� • s l Cesspool: Distance from nearest well__________ ____b Distance from foundation_p..____.__-______-Lining material__-.-_-_._.___--.___---.--------•--- t 1 I �. '.. --Liquid Capacity ❑ Size: Diariseter: = Derntli: ---------- 9 p t Y Privy:' Distance-from nearest well----�------------------------- Distance from nearest building" Y - ` 1JI11 ❑ Distancefo nee"rest:lot line --------------------------- > - - repairing describe ------------(:E '.x-lam -- --- - ------- I Remodeling and/or rep ; g [ �`¢ i Iti t -- ---------------------------- v !'*C"'� ---------------------------•------------------------------------------------------------------------------ -------•----- ----- _- ---------------------------ante with San J-- q to County L _ } _ - —' - ---------------------------_-- _ . �-- :� -- -- -- ---------------- --------- - ----- --- --- I - �. _ a u' y I hereby certify that I have prepared this applica+ion and_#hat the,work will be done in actor ordinances, State rules and regulations of the San,' oaquin Local Health District. r er and/or Contractor] j (Signed)------------------- ----'-�� ----- �-`-S- -- --- ----- - (Plot plan. showing size of lot, location o ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____L` ._�._ -.__-- -------- ------------------- T DATE---�-z � ' 4----------- ----------------- : ----------------------------------- DATE---- --- DATE_.--- -------- -------------------------------------------- REVIEWEDBY = ----------t- ------------------------------ BUILDING PERMIT ISSUED --_------ Y� - �� AiteratiQns and/or recommendations:-- -- � ....... ------ ---------------� ---- `�r� �' ------------ / rites d �_3's =tom` i . ----------�`"-.`--y---•-- a r----� �------------------------------------------------------- ��` Wi t ` fes' /-- ------------------------------------ ----- --- ------ --- - ------------------------------------------ -------------------------- ------------------------------ ---------- ------------------ - Date-----_. ------------- - FINAL INSPECTION BY------------ -- ---------- --- - ------- ---- - S N JOAQUIN LOCAL HEALTH DISTRICT 124 S cornore Street 205 West 9th Street 1661 E.Hazelton Ave. 30 West Oak Street y h Stockton,California Lodi,California Manteca,California t i Tracy,California 9 REVISED 8-59 3M 3•'.3 F.r'•Ca•