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OFFICE USE: �7 ---- -- Permit Noek.. ..... APPLICATION FOR SANITATION PERMIT, . ----------------------------------------------- --------- -(Complete in Duplicate) "I Date Issued --------- ------------------- --- -------------- This Permit Expires I Year From Date Issued ---------- - i Application is hereby made to the Sanlioaquin. 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. ji JOB ADDRESS AND i_VCA T 1 0 N---------8-7-3-Y ------C.......CJV.66em_:S_��_y------------- -------------------------------- ---------------------- --------------------------- Phon ---------_-------------- --------------- ------------- .Owner's Name-------------- Address-_------------------- ----- - - ----------------------------------------------------------------------------------------------------------------------------------------------------- ------------ ----- ------------ Phone---------------- Contractor's Name------ I--------------jo----------------- I Installation will serve: ' Residence X Apartment House E] Commercial 0 Trailer Court F] Motel E] Other El" Number of. living units: __1r____ Number of bedrooms _3__ Number of baths -------- Lot size ------------------------------------ -- -------- Wates r Supply: Public system 9 Community system El Private Ej Depth to Water Table .60- ft. r Character of soil to,a depth of 3 feet:rSand L] Gravel E] Sandy Loarm [] Clay Loam [3 Clay E] Adobe X Hardpan ❑ Previous Application Made: (if yes,date--------------------- No'IX New Construction: Yes .Ej No � FHA/VA. Yes�r No 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-------- r i. F-1 &IST04 6 No. of compartmenis--------------------------Size--------------------_-)-----------Liquid depth--------------------------Capacity-------------------- I --- i n 'm Disposal Field: Distance from nearest wellOW& ---Distance from- foundation----3-0!.--.--Distance to nearest lot line---30-.----- 1571f 1,VT'4 6 Number of lines-----------I---------------------Length of each-line-----------a.10-- --------Width of french---------A—Y-!*------------- 011-00 Type.of filter.,material--- --Depth ofJAkr e1naferial--------/-,&"'----Total length----------------------- ------------- 00 Seepage Pit: Distance to nearest well'.AI&Wl �---_CD' ance' 'fr6im_IKnda ion......./ -r-I- - ante ___.N�fance to nearest lot line.-- �5--------- &V Number of pits....--_ X_ e: Diameter----- Depth-------- -------------- ..........Lining ferial--Zo. is .,dt Cesspool: Distance from nearest well-___--___.------ istance-frora- ounclation-------------------Lining material.-..___-._-._..----.---..--___.--.-- ❑ Size: Diameter---------------------------------------Depth------------------11----------- --------------r--------Li Capacity----------------------------gals. Privy: 'Distance from"nearest well----------------------------------- .------from nearest building-... --------- ---------------------- ❑ Distance to ne rest lot line------------------------------------------itOz----------------------------------------------- ---------------------------------------------- Kemodeling and/or repairing (describe)--------4-A-0--------e-0--------- ------ ------- ------------- - -------- ----------- ---------- --------- ---------- ---------------�; ------ -- -I ----------- --------------- -- ------ ----------------------------------------------- ............. -- ---------- ------- -------------- �,7,2,A--- _4� ---- ---------------------------------------------------- ------------------------------------------------------------------------- -------------------------&&-e ------ 7 ------ ------------------- I hereby certify that I have prepared this Application and that the 'Work will be done in accordance with San Joaquin Court7- ordinances, State laws, and rules and regulations of the San Joaquin local Health District. , 1 ------------------- ---------------------- (Owner and/or Contra (Signed)-------------I -- -----------1.2 --------- --------- ------------------- ---------------- 0 Ic ------------------------------------------(Title)---- By:---- I .. ........ ---------- (Plot plan, showing, size of pl�,�t._i_ocafion o sysreem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE--- APPLICATION ACCEPTED BY------------- ---e�_,;?7ee-e--------------I -- --------------------------------------- ------------------- REVIEWEDBY------------------------------------------------------------------------------------------------ ---------------------------- DATE------ ----------------------------'---------------••------- BUILDINGPERMIT ISSUED-------------------------------- ----------------------------------------1_1�-------------------------- DATE------------------------------------------------------------- Alterations and/or to rete me da+* ns:-------------------------------------- ------------ ----------------------------------------------------------------------------- ........... ---------------- 14S11�f A ------------_-------------------------------------------------- ---------- ---- ------------------- ------------------------------------------- ------------ --------------- .........�_ ------------------ ----- ----- ------------------------- ------- ----------------------------------------- -------------------------------------------------------- ... --------- ---- ---:--------- Date.------ ----------FINAL INSPECTION BY:------- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. I 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 65 9 REVISED 5-59 3M 3-'63 F.P.Cu. 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