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,FR OFFICE USE; � ---------------- / ------------____ -------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. .f.SP........ ' =-------------------------------- ---- ----------------- (Complete in Duplicate) - -------------------:--.------------------- -------------- This Permit Expires 1 Year From Date `Issued Date Issued __9 .... 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. JOB ADDRESS AND LOCATIO ________________________ _ ------------------- ----- ---------------------------------------- Owner's Name_ _9± /,t'_._ h ---------- ----•---•-------- ----- one __ ____ Address00W"/?'._. �- - - -------------------------------------------------------•---•--------------------------------------------------- Contractor's Name------••------s'w�r" _� �� /- --------------------------------------------------------------"--•---------- Phone--------_- ------------------ Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:._/-__ Number of bedrooms Number of baths Lot size `/�,� � Water Supply: Public:system C] Community system E] Private epth to Water Table Ott. Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ - Adobe 9,___<8rdpan ❑ Previous Application Made: {If yes,date__________________-I No WR`� New Construction: Yes Wq^o ❑ FHA/VA: Yes ( No ❑ TYPE OF .INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 41 2e Septic Tank: Distance from nearest we __ ®_____Distant from foundation__.i0_._-___-.0110 -.-_____________- " s/ ----------- [ No. of compartments- -------------------Si _ � 1gwd depth_----- ._... Capacitye/�_____-_-- Disposal Field: Distance from nearest well__-u?'"--__.._.Distance from founda n__ ___ � p - ��'________Distance to nearest low IineT____..__. Number of lines______ Length of each line__ Width of,trench-�____ __________________ 00 CY A.1 ------------ Type.of filter me#erial< Depth.of filter material__ ________Total length--� �----------------------- d' r _ - Seepag- if: Distance to nearest well__ �+� Distance fr fou dation_._: -__._.Distance to nearest lot line_4'��_____ In Number of its___ Lining material_ .Size: Diameter ----------Dept h.4s�_. .................. Cesspool: Distance from nearest well-----------------Distance from foundation------------------_Lining material------------------------------------- ❑ Size: Diameter Depth ---------- -------------- ----Liquid Capacity---------------------------gals. el Privy: Distance from nearest well________________________________________-______Distance from nearest building------------------------------------------ �- ❑ Distance to nearest lot line-------------------------------------------- -- -------•------------ --- -- ---•---------------------------- --------------------------- and/or l - ; Remodeling re airin (describe): _____ p g (dei ________ - r 1 ?0 74 I !� �,_ _7---------_-------4-- --------- --•------ --------- •-------•----------•---------------------------- -------------------------------------------------------------- ------------------------------------------------------•--.. --•------------------------------------------ ---------------------- - __ ______________________________________ ______________________________________________________________________________________________________________________________________________--__._______.__________..._..- 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, an rules and regulations of the San Joaquin Local Health District. (Signed) { - ---------------(�� Contractor) By: l Title ' _ _ Y ----------- ,.r�L { )-- s / �------- ----- -- ------ ------- (Plot plan, showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). i ; FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------1 `mow ---------'------------• DATE----- - _ ?. REVIEWED BY---------------------- -- 1 -- DATE--- w ----------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—---------------------•'--------------- DATE------------------------------------------------------------ Alterations and/or recommendations:---------- ----------- ------------------------------------------------ ---------------------------------------------------------------------------------------- i✓ -, ct r - = - L`� i w 'e ° rc--- ------------------- t1�✓L'f --- •------- -----e ------ -- ----------------------CL .c„ ----------------------- -� •' ' f �� rlY7 FINAL INSPECTION BY:.... ---- � --------------- Date_--- f L--- _`------,.------------ ----------------- y _ I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California. Lodi,California Manteca,California Tracy,California 1 ES 9 REVISED 13-59 3M 3-'63 F.p.ca.