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FOR OFFICE USE: 1 .r - . r _______._____--_. APPLICATION FOR SANITATION PERMIT Permit No. _---7 .. ...6T.7 ------------------------ --------------------- (Complete in Duplicate). 11 ------- --------k- ---- This Permit Expires 1 Year From Date Issued Date'Issu _-,?:----7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thi a plication is made in compliance with County Ordinance No. 549. "A), _ 7—f?o f�/fA/\!7` CF'} JOB ADDRESS AND LOCATION.__.____--_ _ A --- ---6tv -__ r i5 rC _.... L _ �Owner's-Name----------------------- ---------rl^_I Phone.._-- " ---------------------- Address- - ----------------Address_ — �... r r Contractor's Name------------- IUAI�� ------------------------------ --•---1 Phone.- SII-------- ` Installation will serve: Residence Apartment House E] Commercial E) Trailer Court E] Motel E] Onther ❑ 1 Number of living units: _l_____ Number of bedrooms_ry Number of baths _.__:Lot size ----- ----2 C- -S-_----------•-_ Water Supply: Public system ❑`-Community system ❑ Private ®/6epth to Water Table ` ft, Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan j Previous Application Made: llf yes,date-----------:--------) No ZK�New Construction: Yes � o ❑ FHA/VA" Yes ❑ No TYPE-OF,INSTALi=ATION- A-1 DfSPECIFICATIONS: T 'r(No septic tank-or cesspool-permitted if public-'sewer is-available--'ithirr 200-feet:}.�,.A�- Septic Tank: Distance from nearest well___ ._Q_....Distance from oundation__/0_--.____.M tier _ - ._ L;qe '�-- A._. -._. Capacity ' , } �✓ No. of compartments.____��_._--- ----Size____ -. de th_ - Disposal Field: Distance from nearest weil____ ..._.Distance from foundation..- - i �I __.._______Length of each line____ &�' `::__distance to nearesttlot Gne____ ________ ' Type of filter matte erg ia �x __Depth of filter materia � - ---=iota!hlength trench----------- `� p---r--------- G Number oflines__.________ of r f C Seep Pit: Ni��abeaFQ{-n}crest well.---_1�---Q--�Dteraalc��Gf�o'�und�Z�npiameter.--�Distanc to nearest lot ine__._`•�.______._-._ LFT 1� . r p � � f p 9X_9 De th F P I nc r . i-------- ------------ Cess ool: Distance from nearest wet!_________________Destance from foundation.____.-__.___=__ =,Lain matpenaly___.: -� ❑ Size: iameter--:-----`----- ----------------------Depth--------------------------- bLi uid Ca acs# :!... °�m&"i o ------ - -- -- �. Privy: DiP.stance.from nearestiweli-----------------------------------______________Distance.from nearest building I ` ❑. Distance to nearest lot line_________________ _ 9 -' ---------------------1 -----------------------------•------------------------------ ----- ----------------------------- J Remodeling and/or repairing [describe):__ -_ __.______ -.-,1:.•_-----_ y, ' F. --------• --------- -------- -------------------------- -----------------•--- �, �'' ------ ----- ---------------------------- ------------------------- ---------------•---------•- - ----------------- ,i - _ _ Y Y prepared PP e"; , � - n -� ordinances.b trtif-shat l have re Dred this application and that the ork will be done m accordance with San Joaquin County � SLrules-arsd regulafions-of the San Joaquin.Local Healtt District. , ISi ned g - � 1e ---------(Owner an Contractor _ Plot Ian, showingsize of lot,.focation of system in relation to wells, buildings, etc., can[bel aced on reverse side FOR DEPARTMENT.USE ONLY " APPLICATION ACCEPTED BY------< ''�`�" =--------------------------- ---=---------------------- --- DATE--------- ------—_ REVIEWED B.Y_. �`" - ----------------------------------------- DfATE _ _-N t— - ------- BUILDING PERMIT ISSUED__- _ - - - - DATE_ �� Alterations and/or recommendations:---~-------------- -- � `F'!-MA ----------------------- -------------- ---------------------------1_-------------------------- ---------------- ----- n - ---------------7t -----------------------•--------------- �•----------_ - ------- -; -- -- ; -l -- ------- ---------------------------------- FINAL INSPECTION BY:---- ------------------------ ------------------------ Date------ ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street' 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8.59 3M 3-'63 r.Moa, ' T` r