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S. FOR OFFICE USE: -------- ---- ---------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit .. ...... ... . -_-----.---„,__..__ ,,.{Complete in Duplicate) 1JT -------- ------------------------- x Date Issued ------ -�-------ta� ____--------------------------- _______________ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work_herei gocribed. This application is made in compliance with County Ordinance No. 549. `' JOB ADDRESS AND LOCATION-A-Vi)? -. /Itl1✓ A= �. 7 -------- nlG � W ► ------------------------------------- Phone-------------------------------•---- Owner s Name -•-------- G - Q- :. ---------------- lAddress t ---•- I _7 C/�- --- ------------•-•-•------- -----------....... Contractor's N meCQ 2AD � � �: _ - - t7 7• ---A--------------- Phone-------•-------•------_----- ►0 .W... "'�'� Installation will serve: :Resid, encce ��partment House ❑ Commercial ❑ Trailer Curt ❑ Motel ❑ Other ❑ Number of living units: _. `"'Number of bedrooms -2—.- Number of baths ---/. Loo size ----- - - .... - -------------- Wates• Supply: 1,Public system [I Community system C] private [BIDepth to Wafe Table __.. 5 ft. Character of sono a depth of 3 feet: Sand Gravel Sandy Loam ElClay Loa m�Q Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date::.-..:-..__ .._}'�No New Conssttrruction: Yes �J` No FHA/VA❑ FH A: Yes s © No E] :--. TYPE;OF-IN STALLATION_AND_�SPEC iFICATIONS:-!.. (No septic tank or cesspool permitted if public sewer available within 200•feet) E r f , /� ! Distance from foundation_. _4/ Ma aria)_._ ___ . o. ? ---- p $ Se tic�arik: No. of compartments±-- �Q-_-- si --------"--------liquid depth-----��__.-----Capacity_��.`��_- Disposal Field: : Distance from nearest well__�� ..._Distance from fob dation-__�---�__.-:Distance to nearest lot line___ Number of lines-______ -� __ Length o each lin _: Width of trench._._..2 ...____ ---.- " �. Type of filter materiala__ � �__ Depth of,.filte'r material_N'--I ------------- Seepage tf g 'z Total len tF--------- --- p g lfounclation______-_-_F._----.Distance to nearest lot line-_--._--._--_--El U' See e Pit: Number of pits rest well=---Lining maternal e-from .f ..Siie Diame'ter-----------------------Dept h_.._._._..---- `Y” 0 f 1H t Cesspool: Distance from nearest well_________________Qistance from foundation..-.-._.___._______Lining material--._._.___---_-_-._.----__-__-_----. -------.---------.De th_--------------- ----------------------- Liquid Capacity--------------------------..gals. ' El Size:'Diameter__.- - --_ _ p r Privy: Qistance from )ear we L_.___.- --- - Distance fromW nRresf building -..--__-. ❑ Distance t-44 ea�estilot line__..___ _- * -- --- '� 'r ---- -- A Remodeling and/or repairing (describe):- �_ '�-._.__/nr± t�x� 1 f3�e�: cO/UTinr (1c�_ r # r ---- _ --------------------------------------------------------- ----- I--------==---`------ -------------------------------------------------------- - fi !.hereby certify that F have; re a"re��`this application and tha+ +he work w --- ui . . ------------------------ _ _ ordinances, cert fy t a rules and regulations ns li the S n Joaquin Local Hell be done in accordance with San Joaquin County - - ------------------------- alth District. rVP (Signed) - -- _., .-._eA"_ (Ow and/or (Owner Contractor) -------------------------------------------------- -- -- - --- e -------------------------------------- I (Plot 1plan� owing size of lot, location of.system in relation to wells, buildings, etc., can be,placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION:"'ACCEP.TED'BY' ATE_ REVIEWED BY--------------------------------------- -------------`- ------ -- -_._ " -_ ' r 'DATE--- - --• -- ----------------------- --- -. 4 • i 4•rt �y k 1, BUILDINGPERMIT ISSUED--- ----------------------------- -- - � DATE-------------_------ -- -------------------------- n$: - ---- --------- --- Alteea+ions and/or recommendations: Gf AI EFS_r --8 L�----^ 7�}�' ------------ -------- -------------- ---- - tt;� Y t.� ..r1 ------------------------- -------------------------------------------- ----- ------ --�- - ------------ ----------- --------- ----------- ----------------- --------- --------------------- ----------------- ------ -------- -------------- - -- -- -------------- - -- - ------ i I FINAL INSPECTIC7N—Baf6 Date------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Arra. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California a e Lodi,'Cerlifornia Manteca,California Tracy,California ES 9 REVISED 5-59 3M 3-'63 F.P.CO. -