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FOR OFFICE USE: - +- ---- ------- APPLICATION FOR SANITATION PERMIT Permit No. . .... .... ......`` rj/3---------- -----_: ,3 - . _ [Complete in Duplicate) _ . . [ f -- This Permit Expires 1 Year F'1'om Date Issued Date Issued ____�.. .-_ _: __t'7� Application is hereby made to the SanJoaquin 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. _______________________________ JOB ADDRESS AND LOCATION--------------`3--i?------------5�------W_-ft_�-x_C7-f�......... -��='--------'-------------t--- --•-- Owner's NameL:.. -------------- r ---------------- Phone------------------------------------ Address,_. - -� �7 L--------- µ Contractors Name--------- ---------�'�--------sQ 5----------- -IA-O- ------ Phone-- a..R-1 Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer :Court ❑ Motel [] Other ❑ Number of living units: --I----- Number of bedrooms _-L . Number of baths 'Lot`size ___ =_i______�L__2- _U'____________________ Water Supply: Public system K Community system. ❑ private p< Depth to Water Table 6q_ 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 R New Construction: Yes ❑ No FHA/VA: Yes ❑ No 5r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance-from nearest well-----------------Distance from foundation--------------------Material ________________-_______:_______-___--_-_____. i ❑ No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity----------------------- I Disposal Heid: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line__________--_____ i [] Number of lines------------- ----- g -------------Length of each line------------------------------Width of trench......---•-------------------____-- Type of filler maferial-------------------------Depth of filter material-_______________?,_._Tota€ ..k length------------------_. -..--__-___________ ' Seepage Pit: Distance to nearest well-----10& Distance from fciundation �----------Distance to nearest lot line----- -------- 0W0sNumber'of --.------ Lining �lDiater------36.....----Depth- A-11-------------- 'd4 ~LJIr Cesspool: Distance from nearest well--------------- Distance from foundation- ---------------- material--..----------------❑ 4__--_-_______- - ----------------------------Size: DianeDepth Liquid Capacity , Privy: Distance from.nearest well_______________ --------------------------------Distance ,from nearest building------------------------------------------ 171 __.________--_________-____-----.'___--.❑ Distance to nearest lot line----------------'------ -----------------------------------------•-------------------------------------------------------------- ------------ Remo,deling -------Remodeling and/or repairing (describe) Aw- —------ 4t---------1-x- 1-N-I--------=---- ---------------------------------------------- ----------- . E --------------- --- t - t ---------------------------------------- -••-------------------------------•-----------------------•--•-----•----------------------------------•----------------------------------- y 1 r _ _ ___ _________________ __ __________________________________________________________________„_.__-_--.-----_.._______________-._----_________.________-_---------_______----_-_�_______-____:_ ------------ I hereby certify that I have prepared this application and that the work will be done in accordance with Sari Joaquin County } ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. . $ : Y . tJ%_" = l" �+- ------------------------------ - -------Owner and/or Contractor a (Signed)-------•-------- --- - ) By:------ -------12&1-11 •". -------------------------- --------(Title)---------- f } (Plot plan, showing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------C -- --------------------------------------------------------- DATE-------`l v ---------------------- REVIEWEDBY--------------------------------------------------- --- --- ------------------------------------------I----------------------- DATE-------------------------------:'--------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE �,.;' --------------------------- Alterations and/or recommendations:-------_------_------------_-------------_-----------------.--- - ---- -- ��f ak------------------- ------------------------------------- 1 ------------------------ ----- ------I---- ----------------------------------------------------------------------- - FINALINSPECTION -------------------------- ---------- Date------ �1' --------------------------- ------------- SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' Stockton,California Lodi,California Manteca,California Tracy,California 4 E5 9 nEVi5E0 B-59 3M 3-'63 F.P.CC.