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a FOR OFFICE USE: --- Permit No. z6-6 {'� .. /, APPLICATION "FOR SANITATION PERMIT - A , _ ' (Complete in Duplicate) Date Issued --------------- Vis___ __ _ This Permit Expires l 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. 549. JOB ADDRESS AND L CATION_____-�1i--- ---�----- --- --� -- f e ------------------------------ ------ 05 �! --------------- ------ Phone..-----------------••-------------- Owners Name---- � ew Address.----"90A .-------•---------------•----------------------••----,-----�-//------------------------------------------•---------------------------- --------------------•------------- , Contractor's Name----- ,Q-_r.--.. �5"'`--------•------------------------------------------------ ---------------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ dif 00 fi _- � ------------------ ---------- Number of living units: .--- Number of bedrooms _ . Number of baths _"-_____ Lot size __ i Water Supply: Public system Community system ❑ Private F1Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe-�ardpan ❑ Previous Application Made: (If yes,date--------------------I No New Construction: Yes ❑ No R IFHA/VA: Yes ❑ No 91-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation_-__---_________--Material________-_.._---__.--- joyl 1;61 ✓ No. of compartments----- --------------------Size--------------------------------Liquid depth-------------------------Capacity. , .____.Distance to nearest lot line_le---__•_ Dis osal Field-- Distance from nearest well-_- .�.._Distance from foundation__ F. en th of each line___�'__�------------- ----Width of trench_. ___---__._.-_-.-------------- Number of lines g ►"' Type of filter material �� epth of filter material___. -----.Total length.......?v------------------------ i ,.� __.Distance to nearest lot li e_le_---- Seepage Pit: Distance to nearest well______________________Distancef�r Jfo�ndation_-_��` -- " ®/ Number of pits----/---------I----Lining material--JJFiG'l ----Size: Diameter'--------------Depth—"----. --;evg \ _ ni ❑ dLining material-._._---.-_.- ___-__._---_________ Cess ook Da fromnearest well------" --Distance rom ouna ..-:___---_._ l •----- ------- gals. - -- ----- ------ -- ---------- --------- -_Liquid Capacity zeDiameter .__.__ -_ DepthDistance from nearest building------------------------------------------ Privy: _-___ _ ______--____--------. Privy: Distance from nearest well-------------------------------- ❑ Distance to nearest lot line------ ------- A-------------------------------------------------------------------------- Remodeling and/or repairing (describe):__---_.-- i ' -------------------- --- .---- ---------- ----------- ----------- --------------------"----------------------------- ---------------------------------------- ----------------- ' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �✓ ��' 4Q ar or Contractor) (Signed)------ ------------- r(f° ----- --- --- -------------- - -----------------------------(Title)-- By:---------------- buildings, etc., can be placed on reverse side). (Plot plan. showing size of lot. location of syste relation to wells, FOR DEPARTMENT USE ONLY �4--- ---------------------------- APPLICATION ACCEPTED BY------------- --------------------------------- DATE--______ l REVIEWED BY--------------------------------- ---------------------- ------------------------- ----�---- ----------------------------- DATE--------�-------- --•---------------------------- -------- BUILDING PERMIT ISSUED__. - ------------ DATE AlterationsAnd/or recommendations:------------------ ---------------------------------------------------------------------------------------- - ------------ �J =P -------��-7`t=-- - -- ---------- __- - - .--- - --- - -------` �-`--"`��j -'"" ---------- ---- r �_ ------------- -- - ---- = -d FINAL INSPECTION BY:--------- ��-------------------- ----- Date----- e X 10 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.}la:elton Ave. 300 west Oak Street 124 Sycamore Street 205 west 9th Street i Lodi,California Manteca,California Tracy,California I Stockton,California ri5 9 REVISED 8-59 3M 3.-'63 F.P.CD.