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FOR OFFICE USE: ------------------- ------------------------------------- :__:�________________-_________--_--_____________ APPLICATION FOR SANITATION PERMIT Permit No. ...1 (p_ � (Complete in Duplicate). - -- -- ---------------------•---------------- -- This Permit Expires 1 Year From Date Issued Date Issued 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_complice'with County Ordinance No. 549. JOB ADDRESS AND OCATION--- + �J Owner's Name ------------ -- -_ i4-'..1---------- �7� -- ------------- Phon ------------------------------------ ---- -------------------•-------•--- `` Address I J s -�a-� - + ,--------- --------------------- Contractors Name__ `� , p /� ' �#l�.dv-q_---- �-(?_Ell-�'--�'�-��--�---'--`�`�---��f'-'-�---`-----------•----•--- Phonel�-.�:7_~-.�.�k�o--- � I Installation will serve: Residence 'r`°`,partment House ❑ Commercial ❑ Trailer Court ❑ ,JMotel ��rOther ❑ Number of living units: --- Nuber of bedrooms -/- ___ Number of baths ----- Lot size ___1Cd�J�l_! _ ` -------------------------------- Water Supply: Public system ❑� Community system ❑ PrivateV1 Depth to Water Table __-QD ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date --- -.-- I No New Construction: Yes ❑ NFHA/VA: Yes ❑ Nc�] TYPE OF, INSTALLATION AND SPEC11,IFICATIONS: k _(No aseptic tank or cesspool per' itted if public sewer is available within 200 feet.) . - -- lC"4'94 r:air-+=:► -r,. ,.. - � i✓5e'ptic'Tanky 't}istance from nearest well-----------------Distance from foundation--------.-----------Material _____.________.-_-__-_.- 1 II� _-_-___Liquid of compartme Its.-------------------------Size---------- - -- ------ de Pth_______________ --------Capacity-----------=--------;. Disposal Field: Distance from nearest wef1-„54)!-I-.Distance from foundation_aQ-(----------Distance to nearest lot linel_Pvf,-_---�w K - l NJ CF Number of lines_____--__---r________ _________Length of each line-_-__t Pa___ -___-Width of trench.--�-)-��______________-___-� p {�V]� Type of filter material___�,Y 1 Depth of filter materiaL__E�_g___- C9.Q- ----------------------"� ------- Total length_____.f_--- - Seepage Pit: Distance to nearest�Iwell----------------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits------__--------------Lining material-----------------:------Size: Diameter__-.-------------------Depth-----------------------.---------t i Cesspool: Distance from nearest well_________________Distance from foundation.------------------.Lining material---------------------------:__ ____ __. ❑ Size: Diameter--------l1----------------------------Depth-------------------•------------------------------- Liquid Capacity----------------------------gals. a Privy: Distance from nea.(est well---_---------------------------------------------Distance from nearest building----------------------------------- F1 _____---__- _-_-______________.❑ Distance to nearestllot line----------------------------------------------------------------------- ---------------------------------------------------------------------- Remode)ing an4/or)epairing (describe):- 5'7l91& .--Il- --------------`� wlp ------------ ---------------- ---------- ------------------------------------------------------------------- ------------------------ ------------- ------------- -------------•--------------------------------------------------------------------------------------- ------------- ---------------------------- - I hereby certify that 1 have preparJJ�e�,d this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and ri~gulations of the art Joaquin Local Health District*.] eN f r (Signed) - ----`"�!�- ---- Y _.--(fid/or Contractor) $y:. ------------- I---------------------------------------- --------------------------------------(Title)------------------- ----'---- ----------- ----- -------- (Plot plan, showing size of lot, location tf system in relation to wells, buildings, etc., can be placed,on reverse side)., FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------------- ------ ------------------------------------------- DATE----------3-1.7Cz-57-- ------------- -- REVIEWEDBY ---------------------------gip-- ---- -----------------------------------------------------------------------•--- DATE-------------------= BUILDING PERMIT ISSUED---- --------------------------------------------------------------------- DATE-------------------- Alterations and/or recommendations:___t�/.I S�jlY__-__ _______e��£�� J—J—K__TFSE.-�'"-C/,c�a�� ^0 Rc - / -�-+-------------------------------•---------------fin-- .------- -------------------------------------------- ------------ ----- ----------------------------------------- -----------•----------==`-- ------ -------- --- 0:--------------------------- ------- ----------------- ------------------------------------------------------------=---::-------------------------------------------------------------_ ---------------------------------------------------------------- �H--------------------- - - --- ------------------- -----------------------------------•----------------------------------! ------------------------------------ -- ----------------------------------- ----------- - ,-- ---- --------------------------------- ---------- ------------------- ---------------- FINAL INSPECTION 1;111--V--- ------ --- ---- - Date-------, �' + _ SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISE❑ 8-59 3M 3-'63 r-P.CC. l II 4