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FOR OFFIC U �----/!3 APPLICATION FOR SANITATION PERMIT Permit No. ... . .. A ....- {Complete in Duplicate) .f Date Issued --- +` l ---. This Permit Expires 1 Year From Date Issued 1. .7 Application is hereby made to the San Uoaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Counfy Ordinance No. 549. t fir.. ------------------------- JOB ADDRESS AND LOC—A-TSI—ON_______�,�_��____�®{__.___ _1.1_�_��G7y.�_/ .._..._ Owner's Name------------=------ 0----C-dj-Y/l7----------------------- Phone t -- - Address-------' ---------- _. - �� --------------- --- -- -- ----------------------------------- ----•---• ------- Contractor's Name___!_fl. Z _ _:.t ._ -tR �j •--- 4 T-_Al-f/_ i------------------------------------- Phon - . --_.ZZ .-Q•- � Installation will serve: Resident Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living .-- Number of bedroom r. units: � T mbY s _�_ Number of baths �._. Lot.size . 1�-�-�_?'L___,�,�0-------------- Water _---.______._Water Supply: Public system W; tomunity system ❑ Private ❑ Depth to Water Table'69ft. Character of soil to a depth of 3 feet: 1 Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ -New Construction: Yes ❑ N6>4, FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well______________ Distance from foundation--------:___.___-_.Material_:________________._____-_______________________- No. of compartments__________________________Size_-_----_________ Liquid de th___.-:_-____-_- - _Capacity ip osal eld: Distance from nearest well�_�-1?QiDistance from foundation_______-___Distance to nearest lot line__ — ` Number of lines___._._. Length of each line__'_.e---0__f-------Width of french----c.Z. �.�'_________ Type of filter material-. - _Depfh of filter material.__--� g �` , - A �--------Total fen th-•---.._..--•--.....�..�--------- Se -------j Q, . Se pa a Pit: Distance to nearest.well-__.�f4&-Distance from foundatiop.Tied---------Distance to nearest lot line._�_ Number of pits___ _F_____________Lining mat Size: Diameter___,_3i------- .Depth__..,Qi_n�•_______________. J Cesspool: Distance from nearest well-----------------Distance from'foundation--------------------Lining material------------------------------------- ❑ Size: Diameter-------- ----------------------------Depth_---_----_--2---------------------------------------Liquid Capacity-------------=----_------:.:gals:_ •r � : Privy: Distance from nearest well--------- !_________________________..e. Distance from nearest building-____-.-_________________________-.___._. � ❑ Distance`to nearest lot"line___.__ - ------- r -- =- ------------------------------- ---------------------- Remodeling and/or repairing (describe')-----=----- ---------------------------- •---•---•--------------•-- ---••-= •! •-----•----- --- ----------- •---------------------- ------•--•------------------------------------- ---------- -- --- ------ ---------------------- -------------------------- ----------------------------- ---- ------------ -------------------------------- •-----••- --- -- ---------------------- ----- - -------- ---- -------------------------------------------------------- ----------------------_ -------------------------------------------------------------- - ----------------------------------------------- I hereby certify that I have p pared this"applica+ion and that the work will be do in-accordance with Sart Joaquin County ord- la nd rules and re ulations of the San.Joa uin Lacal Health Dis riot. (Signed)---- -----Z-A-L- } -- --- ----�e -----. °�'b in _ Lf J . By:----------- -------------- = ----------------------------------------------- (Ti+le) --------------- - (Plot plan, showing size of lot, location of system in relation t ells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------•- -----------•------------------------------. DATE----- -l-----�-------` - --- - - -------- REVIEWEDBY------------------------------------------ ----------------------------- --------=-------- ---------------------------- DATE-------------------•--•----••----------•------------------- BUILDING PERMIT ISSUED - -----------------------------------------------------------� DATE. AI eatio a d/or recne0a+ions_______ ....... --------------------------------------------- 017 - -----------------•-------------- -� o ( --------- -------------------------- ----------- ----------- -------------- ---- - k FINAL INSPECTION BY:°_: .._+_. ". --------------------- Date----- r ------------------- -------------------------- SAN -- -- -----•- .SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E9.9 REVISED 19.69 P.P.CO.2M 6.60