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_ - FOR OFf-ICE USE: ----------- -------------- ---- -•-�- - APPLICATION FOR SANITATION PERMIT Permit Na. - ............. (Complete in Duplicate) _ D s--- •-+ _ �... � .�^ x ate Issued ._- ]" S17 fi Thi$-Permit•Ex fres-1-Year From Date-issued Application is hereby made to the San*Joaquin'Loc_61-'Health District for'a`permi# to'cons#'ruz:+,and install the work herei described. This a plica+ion is made in compliance with County 0rdinarlce 'No.'549, f► ` �..� • s1 D ter, /R TIANO P - �� J 1 r .fjCJ l .106 ADDRESS AND LOCATION---------- •----- ---------�- -�-----��---1-- ---------------•-------------- - -- -- - ------------- - - Phone_. Owner's Name 6f- Y ---•- - - i ;------------------ .........---•-----••-------------- �/ Address- - '----i'�� 5f kPhone----------------------------------- Contractor s Name________ __ ______ - y � : Installation will serve: Residence 'Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s i / _-Number of baths __1____iLot size x----�`�®------{--------------- . Number of living units:'.!____ Number of bedroom's --- ----- }t i Water Supply: Public;system ] Commu.nity sy_aim ❑ Private ❑ Depth t er T ble 1 •� �Cla'�Loam ; Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand" Gravel ❑-Sa•ndy-L-oam•� y t❑i Y ❑ ❑ PP Y _ .."� - -t. f _ Previous Application Made: llf es,date.__.- _._ _1 No New Construction: Yes [!� ❑ FHA/VA: Yes ❑ No [� TYPE;OF INSTALLATION AND SPECIFICATIONS: )t (No septic tank or cesspool permitted`if public sewer is available wtthie 21 feet. s ' _• C E __�-_ --Size c f X foundation _-._.Material_t _E-QL�i} --- Septic Tank: Distance from nearest well__"___.�____ Distance from q L pth �� - �' No. of com artments_- '7 '' ,, 11 3 � -----Capacity-J.87, ----.- Disposal Field: Distance from nearest well-_C W.-Distlncvo from��undation---`Q_�_. __.__Distance to nearest lot line__�_____...„1,r of filter material___ Q_�- -.-:Depth of filter material '4 width of ire h__ ----� -T Number. of lines_--..-----3--- --- ------------Lengt o eac line"_ ___ £ Type i ---Total len9t ;= y /� F Yp Distance from foundation_-__ . line-- Seepage1 Pit: Distan e,.fo nearest well__..__________._._ _ .' ---.Distance to nearer+ lot _______+ F F a ------- F-1 1 l-- a ❑ Number of pits---------------------Lining material-----------------------SizeDiameter ;: Depth }s Cesspool: DistdhCo from nearest well------- ---------------------------------------------------- from foundation_ - t.l'ining material_____.._______"_____________________ " Depth------------------------------------------- -------Liquid Capacity-------- ; ` ------------gals.11 ❑ Size: Diameter------ ---------------------------- _� ne � s Privy: Distance from nearest:well---------------------------------------------- Distance from. nearest building- -----------.---------------------------� ❑ Distance to nearest lot line---------------------------- --- r -------------------------------- -------- - { -------------------- - ----------------------•------------•--•-------•-------- Remodeling and/or repair�9 (describe):-----. ---------- --- -------•------------ ------`--------- - t _�. _ .�...__:,, :___ �__: __ rr`=-•------'�� --------------------------------------------- a1f■a■�� ---------•-------------------------------------------------------- ------"----------------------------------------------------•---------------t---------•--------•---- I- .. = I -----•----------------------------------g--------------------------------"------------------------------ ------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State""la s, and r les re ulati s of the aquin Local" Health District. ____Owner and/or Contractor >� - rr t I (signed --- ��- - - i--- ---- - ---- ----- ------- - --- ,..�.-'� Br- ------------ (Plot plan, showing size of lot, location of.system in relation to wells, buildings, etc., can be placed on reverse side). .-_ ' 4 r FOR DEPARTMENT USE ON4.LY a , APPLICATION ACCEPTED BY_._ —�-� ----------------------------- DATE--- - I -- 1 � - REVIEWEDBY-------------- --- i�.t r,�+'#T t------- --------------------------------------3DATE-------- -----------------------•---•--------- ------------- BUILDING PERMIT ISSUED---------- "------------"------�'----- - --•- _::_--------------------- DATE - - i Alterations and/or recommenddations:------2;7 57----- � .----- '` - c -----fi ±� +7--- �� ^tom — �f�R_[�_��Tr_o�I� - � � Tl-'•!nL1� �t�o I ` -------------=---------- - -------------------------------------------- ------ . . ..._ ------•--------------- --------- -------- -------------------- _ ----------------------------- -- -------- ------------------------- a Date----------2- -------------------------------- FINAL INSPECTIO - ---- �- - ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Mantecar California Tracy,California ES 9 REVISED 9-59 3M 3`63 P.R.CD. �f