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------------- -_�� f------ APPLICATION FOR SANITATION PERMIT [Complete in Duplicate). Permit No. �• (o Z-- ------"- ---------- -- This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District This application is made in Compliance with County Ordinance No. 549_ Date Issued --��3��6 y for a permit to construct and install the work herein descrbed, JOB ADDRESS AND LOCATION__!__/7_,7_Z Owner's Name__,____i[ I- "` --------- Address------- - Phone. Contractor's Name ,(� `. _ -------•- rt. Installation will serve: Residence - ' ... .................................. ..----- ---- -- Phone..---- ------�Apartment HouseNumber '------•--•--•-- _ of livingunits: _"t--- Commercial ❑ Trailer Court ❑ Motel - Number of bedrooms _ ❑ Other ❑ Water Supply: �--- Number of baths ___2._._Lo} size _-�6 57.� 3 3 PP y: Publics stem ` Y Community system --- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑Pr'Sand E] Depthto Water Table ' " {}, Previous Application Made: (If Yes,date--------------------1 No y ❑ Clay Loam [] Clay ❑ Adobe. Hardpan [] TYPE OF INSTALLATION AND SPECIFICATIONS. New Construction: Yes �`No 'a ❑ FHA/VA: Yes El [!� (No sepfic fank'or cesspool permitted if public sewer is available.within 200 feet.) Septic Tank: Distance from nearest well"�"^� -____-_Distance from foundation-/ _Materi I J� �► No, of compartments-_-X._ a---- ---------size ! - Size------3-,Xd"_-X e ------ -------- Disposal Field: Distance from nearest well- -77777-------Distance from foundation-/_Lt ` th ----Ca acit --------------- p Y. i ." 1 l� Number of lines----_- ---.Distance to nearest lot Ilnet`]~-"" "_-"-. ----------- --------Length of-each line �'' Q = Type of filter materia!` 6Gk -Depth Width of trench.- - -------------------- of fitter material_______ _________"---Total length__"/.5'O `-------------------------- Number ,_"" " Seepage Pit: Distance to nearest well_ pistanc om foundation__./fit________--.Distance to nearest lot line.±-------- Cesspool: - �' Number of pits-__-�- Lining material-" © s C-'t ""-Size: Diameter.__1.,�-'_13p i ..,I Distance from -nearest well-----------------Distance from foundation.._-"-_-__._ Depth _ ❑ Size: Diameter-------------------------------------- ----- .Lining material-------------------------- N Depth - ---------- -------- ---------- ----------------•-Liquid Capacity----------------- r"'Y� Distance from.nearest welt,-"-"-_-.---------------------------------------r ---------gals. C _Distance from nearest building------------- G ❑ Distance to nearest lot line_ "__ Remodeling and/or repairing�(describe).-_ .,.,, "`..' ------�` ----- -- - -------------------- - .. - I _ --------- ---------- # - -------- ------- i --------------- ----- ---------------•- - --------------------------------•---- ------ -------------------_------------.""-"-.-- -----------•------------------------1----------- wr , . ...r- --- ---- --------------------------------------- ---------------:------° -------------------------------------------------- I hereby cerfif that I have prepared this pplica+ion and fhat�the work will be done in accordance with San Joaquin Cou- ordinances, State a s, and rules and r ulaf ns ofithe San Joaquin Local Health District. --- --------- -- y [Signed)-- f Y e 5 u --------------- ------------ F B :. - -- ------ --- caner and/or Contractor) (Plot plan, showin siz4 # act k[Tifle)--=-=----- --- g { ° to f system in e'lafion to wells,.buildings;.etc., can be placed on reverse side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'"--------------A-'-""" '� ' ' _ REVIEWED BY------------I l� -s---- ----------------------------- DAr�- 3° _� ---- ---------------------:-- -_-- � -` 11 BUILDING PERMIT ISSUED ------------` --- DATE F Alterafions and/or recommendations:"_," -" `"" - DATE z ------- -- _I(-- r : ----------- F '-•------'------------•----'---------------e ---•----------•-e•---•----'--- ---------------------------------------- -------------------------------------- • --- FINAL INSPECTION BY: _ ,.. ._ D "., r. �- ate ....... ----- - ySAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Haxelton Ave. 300 West Oak Stree► 124 Sycamore Street Stockton,California Lodi,California 205 West Stir Streef Manteca, California -•-- ES 9 REVISED 9-59 3M 3-'63 F.R.00. Tracy,California