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�O OFFICE USE: .� 7 _ _i 7................ 0 .............. APPLICATION FOR SANITATION PERMIT Permit No. -1.7241V ........................... ................. (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 intae work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.. --------------- ........... .... .................... ------ . ..... ---------- -------------/ --- ----- ........ ------- ...... Owner's Name------.. ................. ----- ----- -- ...... .... ... Worie-----------------------Y__------ 'y...............�? ............... Address-------------- -------- -------- ----------- ----------------------- ...............K ----------------------..........4.-.................... ii�-—--------- Contractor's ----&............_ _ 4. . ........... A....... Phon'eA ...... .......... X -Z7------ ............ InsfalliF6 will serve: Residence E]+Apartmenf House F] Commercial 0--frailer Court F-1 Motel-tl_Oth�r [I, Number of living units: _....._-'Number o f bedrooms ........ Number of aths __;7_L1t_size ; 41?--------------- r I t1. - .. .7 Water Supply: Public system W,&nmurfity system E] Private E] Depth to Water Table ........ ft. I * I Clay F I Character of soil to a depth of 3 feet: Sand 0 1 Gravel E] Sandy Loam�D' Clay Loam Fr-cl Adobe C] Hardpan C] Previous Application Made: (If yes,date........... I No ❑ New Con1struction: Yes Q-10 El FHA/VA: Yes E) N o TYPE OF'JINSTALLATIO'N'AND SPECIFICATIONS: (No septic tank or cesspool p;rmiffed if p'ublic sewer is available within 200 feet.) k Distance from nwell_''.-...__ I a I Septic an nearest stance from foundation----/A!... Mai. .. .. ........................ j ;1i r_? ------Size.-."._ (--Liquid depth.............. ..ft No.Nof.comp&rtn�enfs- --------------- ------------ s a c from fou4datiQ�__, Disposal,4i IJ: Distance from nearest well..7-1-.�,�n e f e**'�K�_�.......Distance to nearest lot line•.......C7 lines.! ..............:......Length of,,each linj. __' "t 7_7trench...'.:. ....._-- Number of __7 _,74 . ........Width of TypeT P of filter rnaferial....... Depth of filter material..-/ Total I n 41h---------------------------------------- nc e Seepage Rit- Distance e to nearest well-n-�_ ` `Distance from foundation...11?........Distance to nearest lot linq..... ....... Number _.Inr�___Lining material_&,!�,, /.......Depth-._.- -7� u ber of pits..j.... Size: Diameler-76." Depth.....g?�I: ... Cesspool: i Distance from nearest well-_.. -.---_-._.Distance from foundation.....................Lining material..................................... .. ❑ Size: Diameter--------------------------------------Depth......... ............ Liquid Capacity.....-....._...--------------ga s. ---------------------------- P Privy: Distance from nearest well --------- :Disfance.frdm nearest building.............................. Distance to nearst lot I;ne................ ........ -----------------........ ------------------ ----------------------------------------- Remodeling and/or repairing escaibe :---- -------------------- ---------------- -- --------- ................ -------------- ---- --------- ----------------------------------------------------------------- -- ------- --------------- ---------------- ....................... ............ .............................. ....... ---------------------I---------- .. ............. I...................... --------------------------------------------- ...................--..------------------------------------- ---------------------m.................... -------------------- ................. I hereby certify fK-af I have p-re-p-aired this application and that the work will be done in accordance with San Joaquin County I. ordinances, State laws, and rules and r g I tions of the San Joaquin Local Health District. (Signed).. K.. .... --- ----------- -- . ... .......................................... _--n-a__(Owner and/or Contractor) 4 ......... .... By:------- ....... ------------------------------......... ........ ...... -------__..-•.._... ••.... --------- ...... ..... --------------- ............. .......... (Plot plan, showing size of lot, location of system in relation to wells. buildings, etc., can be placed-on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--.-__---- -- ------------------------------------ DATE-----. . 6-1................... REVIEWEDBY.__....._--------...............•---...._........._.......----.....----- ...... ......................... DATE----------•--.-:.....:-............................. BUILDING PERMIT ISSUED......................................... .. ........... . ---------- DPTE....................... ............ Alterations and/or recommendations:.......... ... ._/- ....... ............... -1 ..T ..... ------------------------- 'Z' . ........... ---------------------- . ......... -----.----6---------------.................. !.�.,Z.s........... ..........................................................:......................................................................................................................... ... .. .............................. .. ............ ....................................................'....... ............... .......... ...............................:....... ...................................... ............................................................................................................................................ .............................. FINAL INSPECTIO Y%. ....... ............... Date------- .......... ............. ------------- Z- SAN JOAQUIN10CAL HEALTH DISTRICT Jlk;00 We. 1601 E.Hax*116o Ave. 300 West Oak Streel 124 Sycamore Street 205 West 9th Street Stockton,California TLodi,California Manteca,Cofifornia Tracy,Cal l'Forn;* Er 9 REVISED B-SO 3M 3-'63 F.P.00.