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FOR OFFICE USE: N4 9 ---- - ----- ----------- ----- r --. /6 __________________________ _ APPLICATION FOR SANITATION PERMIT Permit No. .....1.12 -: .. (Complete in Duplicate) .:. -- - -- - r'_. This Permit Expires 1 Year From Date Issued 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 o. 549. 09 JOB ADDRESS A � TION-------- r - J....- - . -------------------------- -- Owner's Name 4C�,A 3 ` -r Lr�CJ R� -•--- -- - -------- PhonW., .2. . Address------------•-------- - - - ---- ---------- Contractor's Name / i - `_ cQ��..�Q ! ,:------------------------ •--------•-----. Phone Lt----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ s � Number of living units: _h_ Number of bedroom�_3. -__ Number,' of baths _/... Lot size ----- ...��'---------------- Water Supply: Public system,W Community system [!3Private ❑'# Depth to Water Table' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe Hardpan ❑ ` Previous Application Made: (!f yes;;late-----------:........1 No,❑ New kConstructiori: Yes E] No FHA/VA: Yes E] No ❑ I F . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fad-or-cesspool permitted if public sewer is availabl 6 within 200 feet.) is Distance from nearest well-----------------Distance from'foundation.-._.--_._._--__.--.Material----------------------------------------------- No. of compartmeats--------------------------Size•-..------------4--------------Liquid depth-------------------=- Capacity----- --------------- , isposal Field: Distance from nearest well-/q _Distance from foundation/,J._-.._._.Distance to nearest.lotline._ ._.; Number of lines___________ __________ Length of each line_-'._.-____�!-____Width of trench __5f'�_ ________�_..' Type of fiiter material _ _Depth of filter,material----- ___.-._--.Total length___________________`�-c0_.-..... to Seep ge Pit: Distance to nearest well- n+ -___Distance fromlfoundation-_ .. .__. :.. ce to nearest lot line__-1�2__.-__.i Number of pits--/-................Lining,material.. J' . . - Size: Diameter/`X.9( f........Depthy:'.ra_Z�-_`.........i Cesspool: Distance from nearest well--------------- Distance from��foundation----------------------Lining material _-_--------.............i-------------t ❑ Size: Diameter- -------------------------- Depth--------------f--------,-----------------------:--- Liquid Capa`itY gals V J Privy Distance from nearest well--------- ----- --- -- ---------------,.......Distance from .nearest building _. Of I ❑ Distance to nearest'lot line-- '------------J------- -- -----------------------------------------------------I .-•----•-------------- ----- --. --- ------ -- Remodeling and/or repairing (descrbe):' -------------------------- ----- - � t., �t------------ k. .,7.. ---- - O ------------------•------------•----------------------------------------- .y --- ------------------- .._ -- ;.. '-�. . ,. ---- w F --------------------------------------------------------------- --------------- -= ---------=-----------------------------------------------------------------------------------------........... I herebycertifythat I have prepared this application and that the work will be done in accordance with San Joaquin County , ordinances, tate las, and rules and regulations of„+he Sin Joaquin Loca Health (Signed)- �! - --�-�A�-��-•-., -�jv�� -� - £ ---------------------0w�rter or ontractor � By:----------------------------------------------------------- ------- ---------- --- --- - --- -- ---------•----(Title)------ ------------ - I i (Plot plan, showing size of lot, location of.system in rel on-to wells, bui ingi,'etc.,.can be.placed on reverse side). FOR 15EPARTMENT USE-ONLY+ is r APPLICATION ACCEPTED BY ------ ------------`--r------------------------------- DATE--------r• r REVIEWED BY - --------------- ---- --- ---------` -- I- --------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED - " DATE ;1.. Alterations and/or recommendations:.,-........ . ........�...K..�l---.-_.._. �Y�G - '-.=�------ ? � -A �- -�� --tom -�--- c� r t � ter- �� / z ------------------------------------------------------ - C '_.��--1 � a1.j',...................... ....................F- -----.-.--_.-- t. _ -/'.__........... . _ -------•----- -- -----•-..__Y!_- (� _•--- -•---_ _ •-•------------- ��-.. -- - ---- ----- ----- --=--- - F, FINAL INSPECTION BY:... ------------ .... .-..-- Date_..-------- "` - ----------- SAN JOAQUIN LOCAL HEALTH DISTReCT 1601 E.Hazelton Ave. 300 West,Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 9-59 3M 3-'63 F.P.CD. - ,