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FOR OFFICE USE: ---- ------- ----------------- ---- ------ ------------- APPLICATION FOR SANITATION PERMIT Permit No. ._ �. fP .. -- --------------- ------ ------- ---- -------- (Complete in Duplicate) ExpiresDate Issued f Application is harsh made to the San Joaquin uiPneLoclal Health District From bate Issued - pp y q for a permit to construct an install the work herein described. This application is made in, compli nce with County Ordinance No. 549. 14lV� �� ZIDF- r . JOB ADDRESS AND LOCATION...------------------------____ 9 '`f..."'�"_ - -----�---tJ - D Owner's Name----------_ - � _ . � ------ .._...1 Address---- OL ta Contractor's Name__rq�,PQ1IJ_A_L.b......:5E +q`----S _114; ---------- ----------------------------------I--------- Phone----------------------------------- r Installation will serve: Residence�Apartment House [31 Commercial ❑ Trailer`>Court.1—Motel ❑ Other ❑ Number of living units: --/--- Number of bedrooms-3-- Number of baths�_x, Lot size __�-----------_��___�______- r (� Water Supply: Public system E] Community system F] Private ®/Depth to Water Table,y, --- ft. Character of soil to a depth of 3 feet: uSend Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--- _ .__ l� gT�) No Z1,—New Construction: Yes, o E] FHA/VA: Yes �o El TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if,public sewer,is available within 200 feet.)if ,� v P No. n compartments -____Size_ -- "ncl tion-_�0_�-------Matyr-al__�Q1V ......t'F. Septic T Distance,from nearest well____�_�7 ___ _Qis�ance�rom founda b�lA Liquid der th �F P q P. `f ,Capacity--A Disposal Field: Distance from nearest we Distance from foundat' n___l _-______.Distance to nearest lot Gee__ __..__. Number of lines___.__.A- 04;K __ Length of each line.-'* c�_.p_ __.Width of trench._.__,___ Type of filter material-__ p `� length - --------------------- __.__De Depth of filter material length________1�_Gy_______________________ Seepage Pit: Distance to nearest well._-------------------Distan(te.fromYf--oundation-__--_-_-._!---___.Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.---_------------------Dept h-----.--------------------------- Cesspool: Distance from nearest well_________________Distance from foundation-------- --------Lining material---------._.--.---------------_._____ ❑ Size; Diameter. Depth Z "A!A-- Liquid Capacity----------------------------gals . ji •" ' Privy: Distance from nearest well------------------------------------------------.Distance from nearest building__________.-____________-__.____..___. ❑ -Distance to nearest lot line__________------------------------------------------------------I Remodeling and/or -_____ ___. ftaA![___.FAN_Qrlp ___-_��---Rk+�iMFiII r,dxr-,_4'Y-_t:• - -R_.o - J, -_t,727E = ' -I= 'T�S.- � j i� � „_ �"`; cy R )------------------------------------------------------,T `-------------- t.R,- ?. r , ------------------------------------------------------------------------------------------- 1 hereby certify that I-have prepared this application and that the work will be" done in accordance with San Joaquin County ordinances, StW1wa rule and regulations of the San Joain Local Health,District. Si ned( 9 )----------- --- `---- ----� �-=------��- - -- -- -x----------------------------------f-------- ------------------------(Owner and/or Contractor) By: ----------------------------------------------------------------- --------------------------------- (rile) - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc "'can be placed on reverse side). ---— i FOR DEPARTMENT USE ONLY�,,.' •,R ' .�. APPLICATION ACCP PTSD BY '.R-' `-DATEZ � - ��-------------- REVIEWED =REVIEWED BY---------------------------------------- - -- ----- --------------------------------- -------------•----------------------- DATE-s---_----------------------------------------------------- .. BUILDING.PERM IT..155ifEQ. _:_. :,.-_._-:::---•--=-----------w� __,: = Df4TEY__- ------=`'------ r ._ _ �. __ Aiterationsand/& recommendationis-----------------R---------------- ---------------------------------------------------------------------------------------------- ---------------------------- -- 11 ----•-------------- ---------------------------------------------- -- ---------- ----------__-.t---------------------- ------------------ ---- ----- -----•-- ------ . . �ri ..i Will,.j i s : J"V "tr ----------------------------------- -•-------------------------------- ---------------------- - -------------- ------------------------------------------------------------------------------------------ --- +j ------------------------------------------------------------------------------------------� 20�FINAL INSPE � Date /_. ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.11a:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 9.59 3M 3-'43 F.P.CO.