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r- FOR OFFICE USE: ------ Permit No. ..,�lY..aQ_-� �. -- --------------------------------------------------"-__--- APPLICATION FOR SANITATION PERMIT -------------------------- -------- ----- ,63 (Complete in.Duplicate) Date Issued ____ ----------------- This Permit Expires 1 Year From Date Issue -------- --- _ Application is hereby made to the San Joaquin 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. `JO$ ADDRESS AND LOCATION �/W� 173- f c4.--- '6t-�' - ---S_._. . Phone iES,LI E Owner's Name________ __-� -- '--""- " Address L�=m. - rr •------------------------------- Contractor's Name____.____.. l------------------• Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of baths - --•--- •-------------- Number of living units: _._'�_._ Number of bedrooms-_ y, •---• Lot size --------------- ater Table ,94- Supply: Public o systeem' mmunity._system-❑—Privrate [I Depth to WAdobe Hardpan ❑ Character of soil to a depth of 3 fee+: Sand Gravel ElSandy Loam ❑ Clay Loam ❑ Clay ❑ ❑ 1, ... pFHA/VA: Yes No M� Previous Application�Made: (if yes,date_________ L�a" New Construction: Yes [ �❑ E]TYPE FOF INSTALLATION AND SPECIFICATIONS: - ._=. •. Y - = , [No septic tank or cesspool permitted if public sewer is availalite within 20a#eet:)f ' ------ ------------- Septic ---- --- 'Ma#erial_{--" Septic k: Distance from nearest well----T-_ 'Distance from foundafiion_ t� -Ca acit No*of compartmen't's__1��r .,_= -----.Size--- -'i�'`4� ( Liquid depth ' p Y / , ..._�:..__ _ 1 . ti i r . Disposal Fi d: Distance from nearest well-"-_``-'." -Distance from foundation_ - distance to nearest lot ine_________________ Number of lines-------v -----------------------Length of each line--------------•----v -Width of trench__. '9'------------------------ Number -----_ --:--------- I ❑ Type of filter material_ o-C=1 ---:Depth of filter.material,/..?'______-_ ---Total length____.�7�__"------------- ` A, _-�"```[6 ance from foundation: ""-------------.Distance to neares#lot�llnar___----------• Seepage Pit. Distance to neares _well. -•-_ De th __ s' °---- ---•vu_" Lining naatarial------ --- -----=-----Size: Diameter ----- --- ---- p i }Number of pits= ---- - Cesspool: Distance from neares#.:weil_-._____-_-."__._Distance from foundation-___-_.___-_._.--.Lining material".._..-_.__"___________________�ls Liquid Ca acit I g ❑ Size: Diameter-------------E ------'---- ------------------Depth----Y------------:---------- ---- ------------- q Capacity Y----------------------- t building Privy: Distance.-fromnearest.•well "-_ = --- - f --------- f Distance from nearest Distance to nearest lot line------------------------------------------------- --- ----------------- 1' 3 T .. _ f __________________________________ _____________________________________!________.___..____ g pairingf(desc"ribe]:: � --------- ---------------------•---- - t ------- Remodelin and/or re ---------------------"_---- .. I """-_."_ "________________________________________ --------------- ---------------- - ..________ ...______________..____._________ _ _ ___________.___..___ ..._._ . .__."_________ -- __ . _______________ .. I hereby certify that I have prepared his application and that the work will be done in accordance with.San'Joaquin County ordinances, State laws; and rules an r'k ations.of the San Joaquin Local Health District. __(Owner and/or Contractor) [ ------- - ' � Signed]------------------------ ----------� -- � ---- - - ---- --- -- ---- ----- ---- -- . --- -- -- � T -,� ---r°.�' I e (Plot plan, showing size'of lot; ion of system in relation to wells, buildings, etc., can be laced on reverse.side]. FOR DEPARTMENT USE ONLY-, t - - ---------•-------------------- TE-9II.-- . -21--:�-��---- ----------- -- APPLICATION ACCEPTED BY-----. """ - -� =` DATE=- `- REVIEWED BY--------------------------------------------------------------=----- --------------------------------------------- -�. Q_ DATE = I BUILDING PERMIT ISSUED------------------------------------------- ------------------- x - Alterations and/or recommendations:---------.-------- -------------------------------•------------------- - _:: _._..----__..__-.__"-_--_.__.._.___--__.. _____________�_�____._.__ ••_____ _ --------------------- -------------- _.__.._-----------___.- . _______________ _ __-._ ._.__- y+y, ,ter. ----------------- ------------ ----------- --------------------- Date-- FINAL ate_FINAL INSPEC SAN �SOAQUIN-LOCAL H7~ALT-H..,DISTRICT 1401 E.Ha:alton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California �5 9 REVISED 0-59 3M 3-'63 F.P•C0.