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FOR OFFICE USE: 11 c -7 ----------------------- ------------------------ - ----------- ------- APPLICATION rOR 1ANITATION PERMIT Permit No. ........................ -------------- -------------- ---------------- ---------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued --- -------- -----------------------------------------------------7 Application is hereby m Oe--7 /eZ-_3'� Ae made to the San Joaquin Local Health District for a permit to construct and install the work herein described. T 's'application is made in c6iinpliance with County Ordinance No. 549. OB ADDRESS AND LO AT�ION ------ � --------------------------------- Owner's Name------------ - -------- -------------- ----------- Phone- - 7 -------------- ------------ - --------------- - ------ -- ----------------- Addres4 ---------------/_4-7--- ---------- ----------------------------------------------- Con'tractor's Name_____.__ 10--------------------------------------------------------------------------------------------------------------- Phone------------------------------- _Y '_R ------- Ins011ation will serve: es-iden(ce 2' Apartment House [] Commercial 0 Trailer Court E] Motel [D Other E] Number of living units:'--/,---- Number of bedroom,3-------Number of-baths __2`Lot size -- - ----�/--- ---------------------- 6 Water Supply. Public system! E] Community system El Private t epth to Wafer Table �'rft. Chairacter of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam FI Clay Loam Clay E] Adobe [] Hardpan 0 Previous Application Made: (lf yes,date-.------------------) No W-"'New Const ruction:..,Yes.V2--1qo E] FHA/VA: Yes E] No V� - .11 - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200.fe'et.) Septic Ta k': Distance from nearest well-_47---0-----Distance,from foundation--- id cl,p�h----------- ------ Capaci y - ---------- No. of compartments...... t 4:7� Vi. p, from nearest w -----Distance from foundation ---------Distance to nearest lot line-----A7?�_ Disosal Distance Number of lines_______-__ _�; -------Length of each ____------Width of french.-,-.7—' .7 TYpe of of filter material -filter mafe --- -----Total ------------------- ----- - 0_° � Depth of rial-_ length-------- Seepage Pit: Distance to nearest well.___________ ------Disfante-'from foundation---------------------Distance to nearest lot line----------------- Number of pits----------------------Llni�g material--------___-------Size: Diameter.--------'------------------------- ----Dept h- ------------------------- 4 Cesspool: 'iDistance from nearest well-----------------Distance from foundation--------------------Lining material__._..__-------------------------- Size- Diameter------------ EI ----------- --------- -Depth------- -------------------------------------------Liquid Capacity_..........:_-------------gals. 11 it Privy: Distance from nearest well__._____________-__________________________._Distance from nearest building.__._____..__________._..______-___._____- 4� Distanceto nearest lot line--------- ------------------- ------ ------ -------------------------------------------- --------------- --------------------------------- (clescribe):--------------------------------------- ------- ------------------------------------------------------- ------------------------------------------------- Remodeling and/or repairing,' -- IV ----------------------------------- ------- - ------------------------------------------------------- ----------------------------------- ------------------ ---------------------------------------------------- 11---------------------------- ---------------II-------------------------------------------------------------------------------------------------------------------- -- ------I------------------------------------- - ------------------------------------- - ------------II------------------------------------------------------------------------------------------------------------------ ---------------------it I hereby certify that I have prepared this application land that the work will be done in accordance with San 'Jo-aquin County ordinances, State laws, and rules lles and regulations of the San Joaquin Local Health District. ---------------------------------------------------------- (Signed)----- ---- ---------------- ---------------------------- ------------(Owner and/or Contractor) s�, -,o - ---------------------- --------------------------------------------------(Title)--------- ------------------ - -- ------ ...... (Plot an, s lot.. a n .-in relation to wells, buildings, etc., can be placed on reverse side). _/Si, 01 By:--- ---- ------------ -i---- 'i 'y PI ;,g !location of Sys FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED . BY-- ----- - 5� I ----- ------------ — - REVIEREVIEWED WED BY--------------------------------------------- --------;;------- --------------------------------------------------------- --------------------- DATE----- ------ ----------- ----------------------- BUILDING PERMIT ISSUED___.1i---------------------r-f!71----------------------------- ------------ DATE------ ----------------------- ----------------------- �11 -jand/or recommepiclations: -------------------------------------A,-:7,r ------ --------- ------------ ---------------- ...... --- -------- ------ —-------_e_t�---------- ----------------------- - ------—----------- ----------------------- 2, —------- -- ----C-4 ---------- ---------- :I----------- - - --- ------ ------ ------ ------------------ - ----- -------------- -------------- ------------------- ---- ------------ ---�<,---------- --------- ------- ---------- FIVAL INSPECTION BY:_._/�. = Date---.-,-,.-,------ ---y SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street is Stockton, l California I Lod],California Manteca,California Tracy,California F,P'�13.