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OROFFICE USE: ------ -- - ------------ ----------------- 1 1sf"_ _ T—_='�___�_ _... -�__-_--- APPLICATION FOR SANITATION PERMIT Permit No. __-1A� .t_.F..... ---------------- - —,--- _-�._----- _ ._._. . (Complete in Duplicate) Date Issued ----------------------------------------------------- This Permit Expires 1 Year From Date Issued 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 AND �jLOCATION_ C1r.3 11now-'Fle----------- = ------------------------------------------ Own e r's --------------------------- ----------Owner's Name=1�l ' "s- r� ------------------------------------- Phone. ,�__. � - Address._ ---------------A-��- ------/V-- G1_, = v�+1 1 ------------------------------------------------------ - 3 Contractor's Name-----v -------�,PvC'_-------------------------------------------------- ---------------- Phone..,/zf��_.��...4-.. 4P7 Installation will serve: LResidence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _,I- Number of bedrooms __Number of baths __Z__ Lot size ____1Q.O__ __>C..4570.... ..---------- Water Supply: Public system ❑ Community system ❑ Private 9 Depth to Water Table A?� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IZ Hardpan ❑ Previous Application Made: (If yes,date_--------------- No0 New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I` (No septic tank:or cesspool permitted if public sewer is available within 200 feet.) r SeptiTann Distance from nearest well________________Distance from foundation------------------- Material_________________________________________________ ❑❑� "' No. of,compartments--------------------------Size-------•---------------••-------Liquid depth---- ---- - --------------Capacity-----------••-------•-- Dis os('31l Field: from nearest welL-__ _!__Distance from foundation-----/ '`------Distance to nearest lot line___.3____�.__ S- % Number-of lines------------)ir---------------------Length of each line-------rQO-----------Width of french__________-..-_-.'_------- Type of filter material__ yClG____Depth of filter material-------A ......Total length-------- ------------- i ��'"� Ul Seepage Pit: Distance to nearest well___��1�____ _Distance from foundation------lQ______.Distance to Barest lot line_________ _ _ Number of pits___y__ ....._.__Linir�g materiaL_ p- __-Size: Diameter._-_.r� f�epth______________ _�___ Cesspool: Distance from nearest well----------- from foundation--------------------Lining material___._____-______._______-_._____.___. ❑ :'pry Size: Diameter--------------------------------------Depth----------------------------------------- ----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------,---------------------------.----Distance from nearest building------------------------------------------ .'f..`_ ti ❑ Distance to nearest lot line----------------------------------------------------------------------- ------------•-------------------------------------------------------- Remodeling and/or repairing (describe:__..___-0j;7',,Q_-------'-'n------- -ST ----_'5:"f'�26�--- i ----------------------------------------•-------------------------------------------------------------------------------------- -------•----------------------------------------------•--------------- -- --------- -- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------/d�`....... - -- - ---------- I�L'OVA--- Ely: ' F --------------------------------------------------------------- (Owner and/or Contractor) EI :-----------: r ----- Title (Plot plain, showirig size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). r / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----` ------- -- ----� ----------------------------------------------- DATE--------- •3 - REVIEWED BY------------ ------------------------ ------- -----------:-------------- ------------- ------ DATE---------------------------- - ---------------------------- BUILDING PERMIT ISSUED--------------- - - I.; ------------- DATE------------------------------------------------------------ __ .. Alterations and/or recommendations_____________ -- ---------------------------------------------------------------------------------------------------------------------• ------------------ t.;Y -------------------------------------------------------------- -------------------- - --------------------------------------------------------------------------------------------•---- --------------------------------- ---------- --------- --------------- -- -------------- FINAL. INSPECTION BY:------- r300West ------------------------------ Date... --�---/-�- ------------------------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Mt. Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California o , alifornia Manteca,California Tracy,California ES 9 REVISED 0.59 3M 3-'63 F.P.CC.