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�I 7 1 USE: 1@aa �((ff // ' -- -- - -- l r 7 ff ________________-- _- APPLICATION _FOR SANITATION PERMIT Permit No. .�l__-2 Q (Complete in Duplicate) Date Issued ------------------------------ -------------------------- This Permit Expires 1 Year From Date Issued -.. la r-2SO- 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 No. 549. ''Z ��^ - OL( c uei47 i R OB ADDRESS AND LO ATION___,Z0 JL.:5/'12/j9....j9---- ,�C!- I?.1 �_• i�Ir�4(�---�1-.- / - % Owner's -•---------•------------------------' ----- Phone------------------------------------ "-- k- row------------------------------------------------ Address-------------��-�---�---�-�t�"�- _ � -- -----------------------------------------...---•------------- Contractor's Name--•-----1�49-79e�_ _---------•---------------- ------- Phone.....-------_--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: __/--- Number of bedrooms _X__ Number of baths J--- Lot size __e(0,)L'* _-ftV...------------- Water Supply: Public system ❑ Community system ❑ Private e Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No U30" New Construction: Yes �No ❑ FHA/VA: Yes ®/'No ❑ TYPE: OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) • - ° N Septic Tank: Distance from nearest well_--a0__-._-Distance from foundation_--/J7----.--.Material--e-�r�� t-.__--_--------.-_-. ,1)f [rr No. of compartments-_X------------------Si, eJ�-X-1W------------Liquid depth--�4_1------------CapacitY--gP ------- -- Disposal Field: Distance from nearest well..100---,-.._Distance from foundat�io`--_/+ ......Distance to nearest lot line-Aa...--.-_. _ [� Number of lines---------------.-.7---_---------Length of each line_____ -- ---- F TQ Width of trenchpp Type of filter material_/P�e�-Depth of filter material--.__1- -------Total length--_-_-T--a---------------------------- �. s • Seepage Pit: Distance to nearest well_._,1Q�-_-_._Distance from foundation---�V_-__-._..Dista a #o nearest lot amine--mi -- -_1E �` Number of pits._-/-------------- material-_,040—54---_-.Size: Diameter-_"— -- -------Depth_4v___ _/Nwtc_-_� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.-.-----_------_----.-------_----.i ❑ Size: Diameter---------------------- ------------- Depth--------- ------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------.------------ ❑ Distance to nearest lot line-------------------------------------------------------------------•------------------------------------- ---------------- -------------- -- Remodeling and/or repairing (describe)------------ -- -•----------•------------------- --------------------------------- A1 ��%� ----------------------------------------------------------------------------• •--•--------------------------------------------------------------------------------------------------------------------------------------- J/ -----------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------- / I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy,00, ordinances, State laws, and rules and reg- ------------------------------ ulations of the San Joaquin Local Health District. (Signed)---------- 11-AZ---- -------------------------------------' -----------' -------( $tor Contractor) Sy:-------------------------------------------------------------------- -------------------------(Title)-----'&WAft/------------- -- -------------- (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE: ONLY APPLICATION ACCEPTED BY---------------- --- ------ _--- - - ----- DATE-----------e- ,_x?4 REVIEWED BY-------------------------------------------- V DATE---------- BUILDING PERMIT ISSUED-------------------------------------------------------------- DATE.------------------------------------------------------------ Alter =io�Ta /or r-cecommendation ------------------------------ ----------- ----------------------------------------------------•---------------------------•--•----•----------------• --------� � �-------------------------' ---- Q� - ' - - --------------------------------------------------------- ----------------------------------------------------------------------•---------------------------------------- ------------------------------ FINAL INSPECTION BY:-'-' Date. ' - 7=r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.14axelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9.59 3M 3-'63 r.P.co.