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FOR OFFIC—t-USE: w � -----`---------- ------------------------------- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. . _____ (Complete in Duplicate} 5 _:- ...,�.._...�. Date Issued ------ --------------------------- ______-----------___ _ _ ______ This Permit Expires 1 Year From Date Issued - - - � 2�s—rho--3z _Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta the work her 'n described. This application is made in complance with County Ordinance No. 549. 1 PON f ----o - ----- 1_P -r_ h JOB ADDRESS AND LOCATION._:�_:- ,=.. : -_' 1P 2 -_ ---- - _ Phone - 37/- Owner's Name HAVU-11 ---------------------- ---•--- ---- --- --- Address �r� � I ----------- 1-PQ/�--` rr` ----------------- ---------------- Contractor'sName__ -----iTI _ � !-C-J-- _ = ------ Phone Installation will serve: Residence Apartment House ❑ 4Commercial ❑ Trailer Court ❑ Motel I-] Other E] Number of living units: __�___ Number of bedrooms 3-Number of baths.�___;L�o#siz;" -.F:-_--_----'-___-__.__ t Water Supply: Public system ❑ Community sy em ❑ Priv', Depth to Water Table L_ _ ft. Character of soil to a depth of 3 feet: Sand Ef Gravel ❑ Sandy Loam ❑ Clay Loam ❑ /Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------_____ ) No New Construction: Yes L / I ❑ FHA/VA: Yes ❑ No TYPE.OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer�'is available within 200 feet.} Y Septic-Tank:! Distance from nearest well------- _.-__Distanc��om foundation--------------------Material---- ------------- -_ _-______________________. "1 /!'e�- No. of compartments---------------- --'size----- .41--------------------- depth------------= ------------Capacity----------------------• � Disposal Field: Distance from nearest well--- _.._Distance from foundation__=107"_"-"Distance to nearest lot line--------------- �1 t t)60�"!X + Number of -------;, -.-_ Ler th of each fine �I_�__________._.Width of trench___. ____. b� Type of filter material----GA-,' __Depth of filter,material___-./,'7._____.__Total length-------------5 ___________---______ Seepage Pit: Distance to nearest well----------------------Distant froen fou dation___________________.Distance to nearest lot line----------------- Iti Ces�ool: Distance from nearest well� � _ f�ron•1 foundation 5�e: Diameter____.__-��_..--------Depth------------____--_____._____.__ 1 ` p Distance ndation--------------------Lining material---------------------------------- Number of its------------------- Linin material__ ❑ Size: Diameter----i ------------------- ---- -�`De h---------------------- Liquid Capacity gals. Privy: Distance from.nearest we41________________-------------I-------------------Distance from nearest building------------------------------------------ 0❑ Distance-to'nea rest dotrline--'" -------•-------- _ -------------= �---- --------------------------•------------------------------ - -err••�+� , ~.. Remodeling and/or repairing (describe) ----=' "------------------------ ------- -= = a ------------------------------------------------------------------------------------ --•------------=--_----------------------- -------------------------- -- ' ------------- -------------------------- -------------------------------------------------- ------------- - ------------------------------- rt I hereby certify that I have prepared this application and,that the work will be done in accorda46 with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I .t (Sig ned}= - 1 ------------------ ----------- ---------------------------------------------------------- ------(Owner and/or Contractor} . - 0 y1 By:--- ----- ---- --. � (Title) f '(Plot plan showing size 611ot,-locati of system in relation to wells,- buildings,=etc., can be placed ori reverse side):-=4x^ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- l--i--1�--—=- ------ --------------- ---------------------------------------- DATE--- 3- ----------- ------ REVIEWEDBY------------------------------------------------------ ------------ - ------ -- ----- 5---------- ----- DATE--------------------------- --- --- --- ---- BUILDING.PERMIT_ISSUED-=----------------•------- ---- ----------------- -------•------------------•------ -------<DATE... -------------7- --------- - --------------- Altera`tions end%or �ecammendatiansi__ •- ---- --- - - --------------- ----------•------------- •--------- ------•-- ----- ------------ -- -r ----- � f-------- --------------------------------•--- --•-•-----•--------. � . ' -------------•---------------------• ---- .•a•`` = -------- -------------- ---- - --- FINAL INSPECTIO Y... - ih 7 Date---- -----------------1 ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lod!,California Manteca,California Tracy,California Y Stockton,California . 65 9 REVISED B-59 3M 3-'63 F.P.CD.