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FOR OFFICE USE: --------------------------------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --•-- (Complete in Duplicate) ------ ----------------- --- --------------- Date Issued,=--a24-66 ----------_----_______.___ This Permit Expires 1 Year From Date Issued Appg ation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thi0pplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. --------f- � --- - {J ET " , " Phone_ . - 3 Owner's Name------- -N. � �y+' --------- - - -- �? = ------------------------------------- Address -----••-•-------------- Allillb - - � ---- ; Contractor's Name--- -- -- ---�+-- I----. Phone----------------------------------- -- Installation will serve: Residence A artment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms.?... Number of baths _/_ Lot size _ ____________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previa Application Made: (If yes,date-..-----_.._-..__.} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s wer is available within 200 feet.) .- 7 / Mater�l.---- °C(wapacity---=��_L___=_a______q____Septc Tank: Distance from nearest wek_j -_--__. ._pistance fro _... 4uNo. of compartments..........),---------- l -------Liquid dep.fh------�...... --------- ! foundation 1. Dispo I Field: Distance from nearest�well.__sS �._-Distance from foundation---- ©--------Distance to nearest lot l��e______r-_-__ Number of lines----------�.--------- -----------Length of each line---- 6-6--- -__..Width of french----Av _, . ------------ � Type of filter materiaL____:�f y------Depth of filter materi ------ ------------ length------- _ -___- -0--1- / Seepage Pit: AA Distance to nearest lot line__ er o pi s ---- - ---------- Lining .------ r---- - Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material_r-..._-___----.___._.___------_____ ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------Liquid Capacity------------ -------gals. o .OarsPrivy: Distance from nearest well-----__________________-------------------------Distance from nearest building___._.___.-__________-_-_-_..___.__-. ❑ Distance to nearest lot line---- ----------- - ------------------- ------------------------------------------------------------------------ -- ---------- 4, --------- Remodeling a d/o,{ repairing (descr _ � G /-- J;15� d/� ��l ------- ----------- -------------- -t.=:c �t- --- f- ,5---'� ------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Dis 'ct. (Signed)_._IV/ez : ? !L - --- ---- --- -----------(Owner and/or Contractor) BY�---------------------- •-• ------------------------ --------- --------- - -------- ----------- ------------------------ -----(Tit a--------- ------------------ --- ---------- ------ (Plot - -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I I , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --------- --------- ------- ------------------------------------- DATET 1 G REVIEWED BY---------------------------------- --- --------- - - --- •--- DA REVIEWED - - - ------- ------------------------------ ----- - BUILDING PERMIT ISSUED ------------------ DATE Alterations and/or recommendations--- ----------- ------- -- - ------- -------------------------------- ------------------------------------------------------------------------- - - - ---------------------------------------------------------- -------------------------------------------------------------------- ----------------------------------------------------------------------------------- ------------------ --------------------------------------------------------------- ------ --------------------- --- ----------------------- ------------------------------- --------------- ------------------------------------ -------------------------- ----- FINAL INSPECTION BY:--- ,fes �' -------------------- Date :: SAN J4QUIN LOCAL HEALTH DISTRICT ' 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Co- / 4