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FOR OFFICE USE: c -------------- _--_______---_------------- APPLICATION FOR`SANITATION PERMIT Permit No. ..19f ,fl ' __1-------"------------------------------7------------ (Complete in Duplicate) Date Issued _ I_ - --- This Permit Expires i Year From 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 compliance with County Ordinance No. 9. JOB ADDRESS AND LOCATION_ j '_• �' � g------��LFD-- -----,�-------- d � � -----------�------ Owner's Name __l - = 67 -r-------G_!!�-� t Y`a r: `-' r :._--- Phone-{��'- �Gp--1A Address----------------- ----------•-------•---.....-------------------------------- Contractor's Name--------------- - - T A' --- -------•-•----- = Phone - ,� - Installation will serve: Residence Apartment House ❑ Commercial ❑ Tra er CourF ❑ Motel ❑ Other ❑ / 7/' ! Number of living units:*_j Number of bedrooms _ _Number_of baths _- Lot size __-;-__ - -_-- _ -- ........... Water Supply: Public system Community system' ❑ .Private~ Depth to Water Table357ft. Character of soil to a depth}of 3'feet: Sand ❑ Gravel ❑ ` Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ad0. obe�ardpan ❑ Previous Application Made: {If yes, at'..!~ Q li No ❑' New Constr� 11uctions 'Yes- o'❑ FHA/VA: Yes ❑ No [� TYPE OF INSTALLATIONAND ECIAI (No septic tanVor cesspool-permitted if public kewer is available within 200 feet.) /I Septic Tanks Distance from nearest well-----------------Distance from foundation-_.----------------Material-----------_------_------- ....................... — --A�-='.'__Li uid de thy--------------------;Ca acit` t ❑ j�l� No. of compartments,. =- Size----------_- G P. P Y--- •----- ------ I Qistance from nearest ' Dista ce-from.four_idation.- ,�} f 1 .5 r 4 Dispos Field.h- /LA-_-__---.Distance to nearest lot iir�e----------------- 4 Y - !En� Number of lines----__ -. i- ----- Length of each line'^ e XfJ i g � - f� Width of trench /---------------- �' Type of filter materlal-S ft4kDepth of filter material_--_-I___ �._*Total Ilength_------------ - _ �} //7 f --- --- -- % 4 m fou ation_-_1�--___.-._..Dist nceito nearest lot liria__5 f /' ---------- ---------- Seepage PitVX4Wmber Distance of pits restlweli-----� g maateriial�eo_C0 Size: Diameter�j.--_-�-6-.-__.De th------- - ! P 41----------------------- F Cesspool: Distance from nearest well---------- _---__Distance �r'm foundation-------------------;Lining material------------------------------------- El Size: Diameter---- ------------- ~ --- --- Depth-------- ----------------------------- -------- Liquid Capacity----------------------------gals. Privy: EDistance from nearest well-------------------------- ----------------------Distance'from nearest building--,--,_--------_--- __-----_--.------- ❑ Distance to nearest lot line--------------------------------------------- --------------- ----------- --------------- - ---- . -------------------------- remodeling'and/or repairin (descri el:---- '� - ----con- �1 v �1 -------------------- s .--- ---------------- - .: �`---------��'�'4 -- - I hereby,certify that I have prepared this application and that the work will-be done in,-atcordance with San Joaquin County H ordinances, State laws and rules and requ fioyf the San t -------------------------------------------------------- 1 Joaquin Local Health District: ' (Signed) ------------------ ---------------------------------------------------Owner and/or Contractor) --- ---------------------`----------------1------------------------------------------------------------------------- Title ----- # - -------- -------•--- --------- ; (Plo+plan, showing size of lot, location of'system in relation to wells, buildings, etc., can be placed on reverse side). +: FOR DEPARTMENT USE ONLY APPLICATIONF ACCEPTED BY--- '--------------------------------------------`=-------------- C DATE ------------------ REVIEWEDBY --- ---------------------- ----------------------------------------- ----- ----- --- DATE------------------- ------ BUILDING PERMIT ISSUED_------ --------- - -----------.-- DATE._---.------------ --` Alterations and/or recommendation"s:"---�-..Z;.`+`• �_..� .- - -------------------------------------------------------------I--------------------------------- • -------------- --------------------------------------- --------• --------------•----------------- ------ -------------- -------------•---------------------------------------------------------------- --------------------------- f ---------------------- ----------------- ------- -----•- ---------------------------- ----------...-- •------------- ------------------------------------------------------------------------------------ �. t w FINAL INSPECTION BY:----�5 -- --- - ------------------------------------ Date----- l Z 4 -------- ------------------ i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E'S 9 REVISED 8-59 3M 3-'63 F.P.CO. r