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FOFFICE USE: - GtArw __-_---.--.- - ..- -!-- ?-n__- --- 'APPLICATION FOR SANITATION PERMIT ' ,Permit No. ...!___ !__- _._ - -- ------ --------------------------------- ---------- {Complete in Duplicate) - !Z '_ Thtis Permit Ex fres 1 Year From Date Issued Date issued _______�______ __1G,T 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. -, JOB ADDRESS AN LOCATION:_ _-...-------- — � � � ` 50 ' . r . ! ------------ -- - - n Owner's Name s r - --------:--- ----------... Pharte-_..----------;' } ,,a. t +} Address------------•----------- t_ e_ 3 -•- ....-...___ _: Contractor's Name--- a#.ams• -----=--------------------------- ---- ------ --=-•---- --- - Phone_ .ff Q_ Installation will serve: '-Residence Apartment House E] Commercial ❑ Trailer- Court [D ,Motel C] Other of baths _ L .f Water Supply: Pulblicg units: _-- Numbr of bedrooms -c>?---.Number /.,- iot srze .-- �--- ------ ----- -----••-----•-- -.-- pp y. system ❑ Community system ❑ PrivateDepth to Water Table.� ft. Character�of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ anLoam ❑ Clay Lam ❑l}Clay E] Adobe Hardpan ❑ Previous Application Made: {If yes,date_�_____----------) No El New Construction: Yes ❑ No� FHA/VA: Yes ❑ No ❑ TYPE-OF INSTALLATION AND SPECIFICATIONS:-- (No PECIFICATIONS: ^(No septic tank .or cesspool permitted if-public sewer is available ithin 200 feet.) x v - 5 Tam Distance from nearest,well-------:_�4----Distance from foundation____________________Ma#eri�aL_._____._.___.:-------------------------------- No! ________________ _,_-_,___-,_.No' of compartmenfs1.1-_ Size---------------------1---------Liquid depth s -- .--- ,___,Capaci#y_.--- - --- --- ld: Distance from nearest:well _�Gl.__ _-Distance from foundation___r_7___4�_ ....Distan'ce to nearest lot line,16__4____ 1�2Number of lines---•-'-/.A-__---_ _ ` .mar_ a Length of each I'Ine__--�A_'_---_t---_,-1Nidth of trench_.47�--.--------f----------- Type.of filter materialv�x_, _ . p ! ` t - ___De th,of filter materlal.._: $� ,F-.:Totl length__________________ D___________�- �! Number of its-_____ _- �� Distance m f ndation__ ____._.Distance to nearest lot line �t __-._ 01 --------Lining matenall ---- --.._Size: Diameter--- Depth--a�_ �------------------- R Seepage f it: Distance to nearest we Cess ool: ------- Distance from nearest �' � 4 ¢ P # p waif________________°Distance from foundation.._1___ ___-__----.Lining material._.__._____________.___._________.___. 3 P Y Size: Diameter--------------------------------------Dept - Pg . _.__#____ _______ LI uid 'Ca acit als. ❑ .�. . 1 l r 9 Privy: Distance from nearest.well---------------_-_. _______________-_________._Dista. nce from nearest building______._______________________--___-___._. 1 ❑ Distance:to nearest lot line----------- , ,� -------- _ ------------------------- :..------------------- Remodeling and/or repairing (describe)J _ xR S f _ ____________________________________________ k f! --------------------------------------- -- --------------•------------------------------------- ------------- --- -------------------------------------------------- I : x I hereby c ify that I have prepared this application and that-the work will be done in accordance with San Joaquin County ordinances, St to laws, and rule_ d regulations of th San Joaquin Local Health District. e (Signed) .----- --- a -------- ----- Owner and/or Contractor) by:----- -----•-•-• ._. --- ------ --(Title)--- F - �......................--------------------- (Plot plan, showing size of lot, location of system in relation o wells, buildings, tc., can.be placed on reverse side). FOR DEPARTMENT USE ONLY Y r -----= DATE----- ----� _ - APPLICATION ACCEPTED BY-_ `- - - -- - r 7 L� �� REVIEWEDBY-------------------------------------- ------ --------- ---------•------------------=-------------------------- DATE----- ---------------------- BUILDING PERMIT ISSUED___.------------- =----- - '.'. , - ------------• DATE----�-- -�--------------------- -------- -1 Alterations and/or recommendations______________ yA__'_____� t ------------- -1 --------------------------------------------------------------------------------------------------------- ---------------- - ------------------------•----------------------------------------------- ;-----------------------=-------------------------------------------------- ---------- FINAL INSPECTION BY:._ ' _ Date- --------- \,— SAN r JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California �,L Manteca,California Tracy,California ES 9 REVISED 0.59 3M 3•'63 F.P.CC.