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� rvK QN1(_L USI . .- � rte t ----------------- _ J -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------6—' = (Complete in Duplicate) This Permit EXIDires. 1 Year From Date Issued, Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his ap lication is made'in compliance with County Ordinance No. 549. . JOB ADDRESS AND LOCATION_.___ --- -----x-aw'-_ ---� ,fx _, ,� �© °/ 3-n2o 5 ��(J ------------------ ---------------------------------- Owne'r's __._____-_ Owner's Name-------------- k-_ e---------•rn-'-�-•------�°-- - p _ 1.f � • Zj e -Ph' ------------ ------- ------------------ Address--------- AX Contractor's Name,__ - zv - partment House --------------• ------- Phone-------- Installation will serve: Residence A ❑ Commercial ❑ Trailer Court ❑ Motel a ❑ Other ❑ Number of living units: _.___,Number of bedrooms t.3 _ Number.of aths,_.f-___ Lot#size _ x/JV Water Supply: Public system ❑ Communitysystem y stem ❑ Private 6 Depth to Water Table r45—ft- Character of soil to.a depth of 3 feet: Sand ❑ Gravel Sa - 1 o ❑ y Loam ❑ Clay Loam ❑ =lay ❑` Adobe [Er ��. Previous Application.Made: (If yes,date._- - -) No 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.) Sepfic T •Distance from nearest well _ -`-o"Distance from foundation ' Materi�f_ ------------- sf / No. of compartments-_"-_._.. _.Y_--"_-- �- -----Liquid depth---�'---------------Capacity-� Disposa field: Distance f m,nearest well_-._.D stance from foundation__ ' I y __�a__.x____.Distance to nearest lot line_____�S"_____, rn Numberrof..,lines'_-.---=-, _ Lenpgth of each line----- Q-----` -._.Width of french--------s'Z- ---------- ;•'`� t j T e:of filter,materia �_ 3 YP _" Df th,of filter material-------Af-__-------Total length---------l,,•�.----- " -.� ---- y .p .� g 4-- __, Distance rom foundation to/nearest lot line___ / X Num�beeof nearest w IL- Luing{ material_ -- __-_-_-Size: DiameterjQ_K, Cesspool Distance from nearest wel!-------- g-_-Distance from foundation-------------------- ) -_.._...Lining material_______.._-__------------ -------------------- � ' -------- -------------------❑' Size. DiameterDepth -- Liquid CapacitY --------------------gals.. 1 tl Privy.1 Distance from nearest.well_ _ Distance from nearest building--------------- - . 3 Distance to nearest lot ------- ------------ -------------------------------------------I-------q-------------------------------------------------------- ---- --- Remodelin and'or,repairing (describe): g / P 9 _` *'- .. _ ------------------ �V1 ---------------•-•----•-•--•---•----- ---------------------------------------------------- I;: �- -------------------•-------------------------------------- - •----•---- -- -------------------------- --------------------------------------=------ =--" -= R -------------------------------------------------- -----•--- —I `y - r _ . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' + ordinances, Sfate laws, and rules and regulations of the San Joaquin Local Health District, (Signed)--- ---- ------------- ----- .:� -- -•-------•-- r F (Owner and/or Contractor) J By:.- JJ �`+ P%� (Title)---- a,► (Plot plan, showing size of lot, location of•system in relation to wells, buildings, etc.,.can be placed on reverse side). = FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -` - --------------------- DATE------REVIEW `2 SN ---------- - ED BY------------------ ------------- � ----------- -------------. DATE=------ -- BUILDING PERMIT ISSUED-------------------------------- ------------------------------------------------------------------- DATE----`----- - - Alterations and/or 2 re ommenda.t�ionsf•._-..-4__! ------------ x ------ -- ��------'---= - � - -- - --- 4 ---- FINAL INSPECTION BY:------ -- ----------------------- Date_: -6 T 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 k - ES-9 REVISED 9-59 3M 3-•63 F.RCp, f