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FOR OFFICE U E: , - 1 ----------------------V---------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -146-__�- ,� ----------- -------------------- -----------------I----- (Complete in Duplicate) / -----------=--------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued'.=_:___ - .-X3 i 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. fi I 17V JOB ADDRESS AND ATI N--- --- S/-- -1l- �1IeV '--�-�Q�__)1_.----f.��rt.S!_.(1R14-Fe e i t . Owner's Name Phone. Address----- ------------_--•- ----- .�� Contractor's Name____,¢ ____ a_..- -- ----------•-------------------------------------•--- ---- ----- -------------------------------- Phone----._._.....---•-------••--------- r Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ //Motel E] Other Number of living units: .,)--- Number of bedrooms _Number of baths )----- Lot size _____40-, ---------------------------- ____.____ n Water Supply: Public system ❑ Community system E;/I rivate ❑ Depth to Water Table47ft. Character of soil to a depth of 3 feet.. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe iardpan Previous Application Made: {If es,da��__.___.__,..:_,_-} No New Construction: Yes No PP Y L�/ ❑ [[SHA/VA: Yes ❑ No TYPE OF INSTALLATION-AND (No septic tank or cesspool per-mi++ed if public sewer is available within 200 feet.) f Se tic T Not of compartmentst weir Distance from foundation r,_�------- No.-..of ____ _ t rial_ I P O------:-- ,- - - 5?-- Li uid de th__ ��---------_Ca acit _Lftlll0-Dispd: -4+Mjtance from nearest well__60_. _Distance from founda+ion./#__ -____.._Distance to nearest lotNumber of lines---=----------)-----�------_-_Length of each line---:�AP-�---,----...Width of trench--- -y -/_-------Type of.filter material-- Q___ - --Depth of filter material___ - �- ---Dotal. l e ohnear�of line_S- /- Seepage if� Dis+anc, to nearest well-_� --- Distance from foundation_ O 'Number of.pits._.;___ __Linin material_____ _C Size: Diameter-_ .-------De th___._. Cesspool: Distance from nearest well-_____________,.__Distance from foundation---.--------------_Lining material ...____------------__-___________- ❑ Size: Diameter-------------------------------------Depth--------------------------------------------------- _ Liquid CapacitY -------------------------gals. Privy: r �Distanca from"-nearest well------------- S..-_----.-----__--------_______._Distance from nearest.building------.-----------------------------_----. ❑ Distance to nearest'lot line------------------------- ------------------------------------------------------------------------------------------------------ -------- Remodeling and/or cepa+r,ng (describe)___________ _________ ___ Q_ �-�----;�--- ------ ---------------- -----•---------------------------------------------------------------- ------------------------------------ ---------------------------=-=--------- -_. I 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 regul fi ns of +he San Joaquin Local Health District. — _ (Signed)-- ( `` - ----- --------- -- g )-------------- -- -- -��s--- , _ _ _ _ � ___(Owner and/or Contractor) d BY=--------------------------- �-------- / -----------------------(Tit le).---- 42.4____3 ---- ----------- (Plot plan, showing size of lot, location of system in relation to wells,(0,flings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY w APPLICATION ACCEPTED $Y-- --------------- d-11- -------------------------------------------------------- DATE--------�_-_��'{�.3----------- REVIEWEDBY BY--------------------------•----------------------------------------------------------------------------------------------•--- DATE BUILDINGPERMIT ISSUED------------------------•----------------------------------------------------------------------------- DATE------------------------------------------------------------• j Alterations and/or recommendation :-----.- ----------- ------------ -- -- - - =z 6 ---------- �� ------------9'_:.�---_ t. ------ ---------------- -------------- ---- -------------- `-f r - - ate ---==------------Fic/fin.......................-- -- ------------------ --------------------- ----------- --- ------ ------ ----------------- -----------=-------- --- ---_------------------------- ------ ------- ------ ---------------------------------------------------------------------------- ---------- ---------------------------------------------------- ------------------------- FINAL INSPECTION $Y:.----- --------- ------------------- Date..... T-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Avo, 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3M 3-'63 F.F.CG. I