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_ �_._... ------ APPLICATION FOR SANITATION PERMIT Permit No. ----------------- --------------------- ----------------- (Complete in Duplicate) ------.-.--- This Permit Expires ] Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct a d install the work herein described. This application is made in compliance with County Ordinance No. 549. L/NbrN h'o% �n,/� l/ � � is' JOB ADDRESS AND LOCATION-W?---- ------�';g-------------- ---el . --------------M. )euA4S trO. 4,9w7- Ike. ------------------------------------------ Owner's Name----- Address `7 '` fir'Il_ / ------------------------------- -------------------------------------------------------------- Contractor's Name_._____ ' 1 !u ----------t-------------------- Phone....1.1-z'J6 96d_Y Installation will serve: Residence J2-- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: ___l__ Number of bedrooms _��r'_- Number of baths ---.1__ Lot1,size .___-_ __. ____.!1_ - ___________________ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table 00_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam R' Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------------------I No e New Construction: Yes ❑ No p--FHA/VA: Yes ❑ No E TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) r�0 Septic Tank: Distance from nearest well_________________Distance from foundation-------------- -----Material----------------------------------------_----- ❑ No. of compartments---------------------- ---Size--------------------------------Liquid depth-------------------------Capacity----------• ? -- i Disposal Fiel Distance from nearest well-_/QO_.._._Distance from foundation-___1Q-'_____.Distance to nearest lot line------ - � �.= " � _- --- E_.'�_A i � Number of lines______-.____ ____________________Length of each line---------- of trench.____-_- _,2 ____________ , a� Type of filter material___�Q ,/C-----Depth of filter material______ +F"--.Total length_____________________ _'_______ Seepage Pit.'j,,, Distance to nearest well___l0,j........Distance from foundation_-_..e!-'_.__.Disfance�to nearest lot line__._til ® Number of pifs.:---- -�/------------Lining material_. /C_...Size: Diameter------- Depth------------ *�* Cesspool: Distance from nearest well-----------------Distance from foundatian--------------------Lining material_____________________________________ ❑ Size: Diameter----- ------------ -------Depth------- --------------------------------------------Liquid Capacity---------------------------gak { Privy: Distance from nearest well------_____________________{____________________Distance from nearest building ❑ Distance to nearest lot line--------- --------------------------------------•------------------------ { Remodeling and/or repairing (describe):-------/-/Wl------7Q......ef—f �.�1Y 62-------4S-Y-T7- ---------------------------------- ---------------------------------------- -----------------------------------------------------•------•--------------.----_-------------------•------------------------------------------------- ---------------------------- I hereby certify that I have prepared this application and that the work will be done,in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed} .- ... --------- ---t----------------(Owner and/or Contractor) By: Q-'ter:.... ---- --�==��--------------------------------------------------------{Title}--.------__�.� __�.---'-.--- -. -....... ................. (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------..ep...... - DATE rp` = . f REVIEWEDBY------------------------------------ ------- --------------------------- ----------.-------------- -----------------------. DATE BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------- ---- DATE-------- . Alterations and or re�com rendations:-_-___ �L. a f T ---Z`�9 -ry'� �/L[►d. � - .---- -�-•-`�_'.-*:-.�'�-�---==tom_--�= `"-`-=---� ----------- r_1r------------- : c -��f j 9 `-- j� J - ---------- -- -^� --` �fcz� c{L s .-t-�-�-_._._ ___ ._.__ -t_�i-� ...� fes.. q..... . - 4 --------- _ - ----------------- ------- --------- ------------------- --- - - ----•---- FINAL INSPECTION BY:......... ..... .. - f Date-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazellon Avo. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 RevMro 9-59 3M 3-'63 F.P.CC. Ij