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FOR OFFICE USE: V <br /> ...................:.......... .................. ------- 0 -'- <br /> APPLICATION FOR SANITATION PERMIT Permit N .................... <br /> ............................. ................. ........ <br /> ........_.......I..•..•• .....Z-7 7 ----------7..7... <br /> (Complete in Duplicate). Date Issued ..::�/t-�P. .-•�� <br /> This Permit Expires 1 Year From Date Issued <br /> stall Application is hereby made to the San Joaquin Local Health District for a permit to constro,all the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> C>Os- 3-f7O-Z-7 <br /> JOB ADDRESS AND LOCATION......... ...................... -/f_,ft/jt <br /> ............ <br /> Owner's Name. 414.,,It. ... .................................................--------- ------------------------ Phone.. . <br /> - ............*........ <br /> Address....---------- ....... ... ---------- .................... ..............------------------------............ ..................... <br /> Allpf"_1P '"t.. Phone..........-----_----------------- <br /> Contractor's Name 9 <br /> Installation will serve: Residence Apartment House [] Commercial 0 Trailer Court ❑ Motel C3 Other E] <br /> Number of living units; Number of bedrooms A%. Number of baths size .... . . ....... A ............................... <br /> F <br /> Water Supply: Public system El.! Community system 0 Private [I Depth,to Water Table A ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [1 Sandy Loam 0. Clay Loam QClay El Adobe C] Hardpan ED <br /> I <br /> Previous Application Made: (if yes,dote... -------;--- ....1 No [M New Construction: Yes No C] FHA/VA: Yes F No 0 <br /> TYPE OF INSTALLATION AND. SPECIFICATIONS- <br /> AN* septic,tank or cesspoolpermitted if public sewer is available'%!'jfhi'n-200 feet.). <br /> t l',-f f `dafion-,4t�--t­ Maforial7uW-Vu.A.............----------- <br /> Septic 4-ank: .:Distance 4rorn near6st--well- ­...Distanip rom oun ------------_--- <br /> ... <br /> No. of compa�tments........... -------Siz lAnIA...fs.......Liquid depth........ ...............Capacity................-... <br /> L-I <br /> Disposal Field: Distance from nearest well_-,5'Q..........Distance from foundation...L..-----------Distance to nearest lot ane-s 9............. <br /> Number of lines....._......_-_1 '7 ...Length of each ................Width of trench._._i& ................ <br /> 4P 'P�i <br /> ?7D`ep'+h_`of­fiIt.e_r materiaL-4-9......'----..Total......Total length----- <br /> Type of filter material 0 <br /> Seepage Pit: Distance to nearest well-J....�J----- Distante from foundation.-_.:____-__ -----LDistance to nearest lot line.................#.000' <br /> Number of pits.............. ng material................ ....Size: Diameter.-!...................Depth--------­----------------------- :�fl, <br /> ❑ a to <br /> Cesspool: Distance from' nearesf'w1II.,0......... Distance.from# <br /> ounclation---------L!....I.-iining material...................................... IN <br /> 0 Size; Diameter-----------------• .......�-�D,pth__._-_--------------- -•--------- -- _t---!_Liquid Capacity............................gals. <br /> nearest well-.,............................................Distance� fr nearest building----_--------------_ <br /> Privy:_ ...Di'stance from 04 - <br /> "'Distance to nearest lot line....-------...........----------------------------------------------..................................................... ............ <br /> .................................. <br /> Remodeling and/or repairing (describe):....4Zo4. .................. ................ <br /> .............................:.................................................................................................. ............... <br /> .................................... .................... <br /> +� 'K .................................................................. ......................................... <br /> ..........I............................................................................................ <br /> - - --- <br /> ................................................................­­..............__-------------:................... .. <br /> ....................................................................-----------n------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> .............­........... <br /> (Signx)------ 0 ...................I....... ............. .................................. ------(Owner and/or Contractor) <br /> ..........U.-A ......... ........ <br /> -8y:L....... ...... ..................(rifle)----------:............... ------------ ..................... ... <br /> (Plot plan, showingsizeof lot, location sof system in relation to wells, buildings,'.etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY: <br /> Yi' Ad' ---------------------------- <br /> APPLICATION ACCEPTED <br /> DAT <br /> REVIEWEDBY..................I...... ...................................... ................... ........................ DATE........... ----------------------------------------- <br /> ............._----------- ------................L................. .................. <br /> BUILDING PERMIT ISSUED....---- DATE-------------------------------------- <br /> ....................:. ......... <br /> Alterifions•and/or recommendations:_................................................................................................................................................... <br /> 11, ................I-—........................ <br /> ............................................................. .....................___.................... .................................................. <br /> 1! ............................................ ............. ..................................... ..................................... <br /> ............................•--••---.._......•••--•-•-•-•----....... <br /> -­--------------­­.-..................... ..................._.................................................................................... <br /> ....................................................... <br /> t .......................... ................... .................................... <br /> ...................................................................... .........:­................................................. <br /> FINAL INSPECTION BY:. ----------...... Date-.../... ..........................................------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 6-69 3M 3`63 F.F.00. <br />