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FOR OFFICE USE: '! I : 9 77 -- Permit No. - �....--'•- �f,. --------------------- ---------------------- _r_______ APPLICATION FOR SANITATION PERMIT - [Complete in Duplicate) ------------ ----- -------- -------�: - � � Date Issued ----------------------- --------- -----•-------------- ----------------+_,_"".--- ----. - - - __a_". This Permit Expires 1 Year From Date Issued A lication is hereby made to the:San Joaquin Local Health District for a permit to construct and install the work herein described. Thisapplicationis made in compliance with County Ordinance No. 549. JOB ADDRESS AND .00ATION,'_ �/� _ _ E� � Owners Name--------- ----- Imo---- � -�-�- ----------------------------------•------ ----- -------------- -------------- �-- - Phone"T"� --: f , Address--------- ------_-------- -- i g �'' Phone --....."" Contractor's Namet A---- -------- - '-.rC=--- --- -•----------- t Installation will serve: ,Reside nce'V Apartment House E] Commercial E] Trailer Court C] Motel E] Other El Number of living units. JJ Number of bedrooms ,,�"" Number of baths;._-.,<__ tot sae.:x�__�___.---?�-___-� - ---- -------------- - :. # apt. i ft Water Supply: Public system. �) Community system E] Private ❑ Depth toWaferTable - t Character of soil toa depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ :�. t I s Na Previous Application Made:! {If yes --------), N New Construction: Yes ❑ No FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t < (No septic tank or cesspool pt ermi#ed if public sewer is available within 200 feet.) + Septic Tank: Distance from nearest well_--""""".__""---Distance from foundation""._""""""""- -___".Material""""""""-""""-..__-_"..-___"__-_"."".-.".--_--". ❑ No. of compartments--------------------- ----Size------------------------ -------Liquid depth------------- -----------Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- r ❑ I�of lines- Length of each, line Width iof french---------------------- Type offilter material-------------------------Depth of filter material-------_.-------------Total length-----------------_-.-------------------- Num er I � 4 �l I . ` 1 � -"�! See age Pit: Distance'- to nearest.well--_Mb!C---Distance m foundation""."..T40--_----Distance to nearest lot line.""� Numberk of pits ""-"."� Lining material---- k_.Size: Diameter-----_.9 .-.___Depth------------ �1____..____- -------- i Cesspool: Distance from nearest well from foundation--------------_---.Lining material___-."..--_"___."". _"_._. k ` --------------Liquid Capacity------------------- gals. ❑ Size: Di'ameter--------------------------------------Depth-------------------------- Privy: Distance from nearest well----------------------------------- ;?._Distance from .nearest building-----------_------------___----------- w fl- ❑ _e _e ... �,, .� �. �. •.. ----------------- � Distance to nearest lot'line _7___- ------�---�� ------a'------- -------------•-----•--------------- - ----------------- - ii , Remodelin and/or repairing t describe 1 ��,Cy�.------- -�5% f . ---•------------------------•--•---------------`----------- --------•-------------- ----------------------------------------------------- I ---------------------------------------------€----------------------------------------------- ,i , ---------------------------------------- -- -- --- ------ -= ----------•--:---.--:--------------------- = - ------------------ I hereby certify that I ',have prepared +his applica+ion and'thaf the work will be donelin accordance with San Joaquin County ordinances, State laws, and rules and:regulations of the San Joaquin Local Health DisfrA E E -------------- (Signed) -.(O er and/or Contractor) ------------ `C%L2sG --- - SY� Title -...- (Title) (Plot plan, showing size of ht, locafl of system in relation to wells, buildings, etc., can be placed on reverse side). .t I� ( FOR DEPARTMENTfUSE ONLY ' APPLICATION ACCEPTED BY '� ---------------------------------------------- DATE ---------------- DATE_-.----"_ REVIEWEDBY------------------ !�. i ------------ -----------------------------• ---- BUILDING PERMIT ISSUED---------€ --- -------- ------r------------------------------ ---.;::a�:::ard,ATE_ S,. _._.—_..�.�..�.�- Sias Alterations and/or recomtriendattons------------ _� � - �' :"" """ ,""" - t ----- ---- --------------------•--------------------------- ------------------•----------------------•---.. I� i --------- ---------------•-=--------------- ------------------ ---------------------------- ------ �., ------ Date---- ------- d '�f/�/' .,... XYZn��—_.._-- i �- f._--"....L--". f.�"_-_ --""_---_- --------- --- FINAL INSPECTION BY: �- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetion Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California:N Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.P.CO. ii