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-FOR OFFICE USE: .., -------------------- ----------------------------------= ------------- APPLICATION FOR SANITATION PERMIT Permit No. . ........ .. • �' ' �� (Complete in Duplicate) _ �J f ------------- -- ._ - Date-Issued ------------------------------------------- ------- -- This Permit Expires 1 Year From Date Issued 300--f 5' Application is'hereby made toithe 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. LATHRO:F> JOB ADDRESS AND LOCATION-------------- 14dV -.-- ESD = l..11_ � ,� _ RoT H-------- -----R�.�----------------=---------------- Owner's Name j__�.-------_. ��___Bu_pvxs--------- -------------------------------------- ------------------------- Phone--------- --------------••---------- Address-----------1 + I -` -- _- QST-=----1 1--�'-------F �1v---- --------r. } _P.----------------------------------------------------- ----------------- Contractor's Name_ __._QIhfN_ ._ " 1 ''-''-� '- �f '""" `Jy � Phone `_ 2 Installation will serve Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ ' a 2Q� Number of.living units;____{___ Number of bedrooms _- g _Number of baths __ Lot size.----.. �1�:= Water Supply: Public'system)❑ Community system ❑ Private Ef'Depth to Water Table ._-- ft:' Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam ❑ Clay Loam Clay ) Adobe Hardpan f ; Previous Application Made: llt yes,date________._.;___.__-.l No 21---N—ew Construction: YesNo ❑ ( FHA/VA: Yes No ❑ _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No sseptic tank or cesspool pernnitted if public sewer 1s available within 2©0 feet. "� r ^•"�""" fQ__#_l. Se tic Ta k: Distance from nearest well___�l"�i -----Distanc from foundation_.___ __ aterial_._ ._ _ ____ � __._______.. N ti Ta depth--- --f --.'._,Caa llo. of compartments_______. ..__-- Size___. _ . Disposal field: Distance from nearest weal___, Q____-Distance- frg found,�tion____�. __._ . .Distance,to r;ea1 s t lbt lYie___ p t . 3 r Number of lines---------- Len fhrofacfi�le______ ___ _._________ Width of trench___ - _ .____ _------- 9 i' >, Type of filter. material---)_? ..-C-r1 Depth of filter material___..ig-_____. _ _Total length 11 ' Seepage Pit: Distance to nearest well_____________ ______Distance from foundation____._________.___.Distance to nea4 s lo't line ------------- _ ❑ . p -Size: Diameter..__. Q Number of its--------------------- Lining material--- -------------- - - ._._�, _Depth �----- ------- - - '� Cesspool: Distance from nearest well--------------_._:Dim stance from foundation_____________:Y'Lining m: er;a,1 . ..__•____..___.___,______--_____. " ❑ . Size: Diameter------- ----- - -I -Depth --------- - ------ ---------- --- .._Liquid Capacity ° ------•_gals. � --- Priv Distance to nearest�lo will--------------------------------------------------� Distance,from nearestbuilding-�----�-�-�---'-------------------- - ❑ Dista F , it Remodeling and/or repairing (describe)._ ---0^ ----� ------�--- -----_� ------- �`�- -- ©p�~" 1� . r r 5a Aa # ------------------------------- ----------------------------------------------------- ...... t _ hereby certify that I have prepared this application and tl at the work willrlie done in accordance with San Joaquin County ordinances, State laws, and, ruI s d e�,iff Joaquin Local Heal District. [Signed]:.. a a..rt .____(Owner and/or Contractor) - Y ------ „� [Plot plan.4showing size of lot; location of system in.relation to webs„buildings, et ..can be placed on reverse side). a * 1 L,, ,..—F.OR..DEPARTMENT.,USE.O,NW .APPLICATION by ---- - 7?,0- ---- ----- ------- DATE ��'��3 '45 REVIEWED BY--- -------------------- -- ------------ - DATE------------------ ------------------------------------- BUILDI�G�P,ERMIT ISSUED - ------------=----------------- ------------------------------- DATE------ �. Alterations-And/or recommendations------------------------------------ -- ---------------------------------•------------------------_--------- -------•-- ----•--- ------------- •-------------------•-------- --------------------- - ----------------------------------------------- -------------------------------------- ------ ------- --------------------------------- --- -- ---------- - . ----------------------------------- ---------------------------- ----------- --- ------- -- ------------------ -------------------------- _7yl � FINAL ISPECTI BY ------ ------------- -- - -- ---- - Date- - ------------ --- --- - ------------- N SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F5 9 REV15E❑ 8-59 3M 3-•63 F.P.CO.