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FOROFFICE USE: 4% ------------- ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. i. ---------------------- --------- This Permit Expires I Year From Date Issued -----------------------—------------- -------- (Complete in Duplicate) 'Date Issued Application 6 San Joaquin Local Healfh District for a permit to construct and install th York described. This ication is hereby made to the S herein descrapplication is made in compliance with County Ordinance No. 549. JOB ADDRESS -v AND LOCATION..W.- P.....16-----OF---- ---q--------R>* Owner's Name v ...-A17Z----- --- -------_F_ DEDT?A.R_1--------------------- -------------- ------------------ Phone-----_----- --------------- AddressX-,... ......... Contractor's rs Name-MoN-T ------SiFen -.-15-r i j5��--------------------------------- Phone----------------------------------- Instation will 75-rer�e: Residence Apartment House E] C6Mmertlal'L] Trailer Court 0 Motel [I Other [I al l Number If living units: __.___!Number of bedrooms 9,. Number of bath Lot sizeA�.-kEAG.F:........................ Water Supply; �ublic system El Community system [I Priva to 2---Depth TO Water Table Character of s;iAo a depth of 3 fc at: Sand (,Gravel E] ,Sandy Loam e Clay Loam E] Clay E] Adobe E] Hardpan E] Previous Application Made: (if yes date____________________) No New Construction: Yes g?"`No E] FHA/VA. Yes 0 No TYPE OF INSTALLATION AND SllECIF' ICATIONS: (No septic tank or cesspool permi ;Pif public c s`we� is"vai I Septic.,Xa ank: Distance from ne' re well__f� _Distance from foundation----/0------Material---02&A_91_AE ........ No. of compartment ------- --------- Liqtid.,,clepth----- - Cap8c4V_ZV_C> Dis Field: Distance from neo s we -------------- __DiArf i I W ro-u no War.674 Diita-F-c'e"'fo nearest loi'line_:57...... 0 -10. 't� line_U - --------- Width of ranch,- Number of lines_____ . ......... _"_'"fie of each I' ............... Type of filter mate ----De th of * .4'� ---- filter mate 655,tiR .........Total length--------- ------------------------- le L.Of I& Seepage Pi+ Distance to nearest well----19497-� -------Distance nearest I no & is ---- ----------- Number of pits---------.j----------Lining maferiaI.4R_0.C_KN_.Size: ame Depth______lotry A Cesspool: Distance from nearest well-----------------Distance from foundation------------------t Ming ma erial------------------------------------- .:El Size: Diameter------------------------------------- Depth:------------ ----------------------------t-S3 Liquid Calacify---------------------------gals. Privy: W "T- �t —M,�i t 9-----------1-1 ---------------- Distance from nearest well__________________ Distance from ne�alrllf 61 i 0 Distance to nearest lot line_---__----------------- Fi _"_Distance ------------- - ------- -- -- ---------- ------------ ------------------ - - - --- 4 Remodeling and/or repairing (describe):--------------••- ---------------------------------------------------------------------------- ---------- -------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------- -------------------------------------------- -------------------------------------------------------------------------------------------------------------- ----------------------------- ------------------------------------------------------------------ - -------------------------------------------------__,------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby rtify that have prepared this application and that the,work will be done in accordance with San Joaquin County ,ty ordinances, S e I s, an rule ctand regulations �fhq San Joaquin Local Health District. wa(Signed)------- ......... --------- -------•--•-- ------- (Owner and/or : ontractorl By:-----_--------------------------------------------------------------------------------------------------------------- -_ .............. .. (Plot plan. Adwing'67te of lot.-locatlor of ells,-buildings;*etc:;-can-be-placed,on-reverse sidb).7--- FOR DEPARTMENT USE ONLY -------- APPLICATION ACCEPTED BY----- 7 ------------------------------------------------------------------- DATE--- ---- ---- - REVIEWEDBY--------•--------- --------------------------------------------------------------------- DATE--- ------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---- -------------------------------_--_----------------- Alterations and/or recommendations:-- --------------- ------ -- ------------------ ..................... ............ ................. ------------- -----------•-•-------•----- ...............1-1 ------------------------------------------------------------------------------------------------------------- ----------------------------------------I----------- ----------------------------------------------------------- ------------------------------------------------...... --------------------------------------------- -------------------------------------------------------------------------------------------------- ...... ----------------- ...... .. ... ... ----------------------*--------*---*------------**--------------------------- -------------------------------------------- -- --------- ----- -- -- --- - ---------------------------------------------------------------------- ------------------------------------- _R------ ----- - -------- ------ ---------- FINAL IN N . .. . . . ------- ---------- --- - Date----- -- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Stfoot Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATt_AS