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I-UKUrrlCt USt: --------------- ------------------------------- I- }------------------------ -------- APPLICATION FOR SANITATION PERMIT Permit No. ------------- «.--- ------------------- ------------- (Complete in Duplicate) -} -- __- This Permit Ex ires 1 Year From Date Issued Date Issued =-- ------_7 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 de in compliance with County Ordinance No. 549. JOB ADDRESS-AND OCATIOATHR0r___,_,R- t>'- ..... ---OF----- -.f�{IQ�t-----°-RA,._.... Owner's Name`-------�ERB ---- ]a��.�� '-------------•------------------------ - ------------------------------- P -----•-----•-------_----•-------- .p Address--------- .. one t Contractors Name QI? ;5AIpartment ------------2.770_(v----LAIN--�P--9_k---1QV� Phone..Lu Installation will serve: Residence House ❑ Commercial ❑ Trailer Courf ❑ Motel ❑ Other ❑ Number of living units: _1_----- Number of bedrooms-- Number of baths ,fe?-- Lof size ------1-74? X-I�20_r"___"""".""--------_ Water Supply: Public system ❑ Community s em ❑ Private Depth to Water Table �^ ft, Characterof soil to a depth of 3 feetCSVd IK Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe ❑'Hardpan ❑ Previous.Application Made: (If yes date. ��'._--_,'_-.) No`K New Construction: Yes �No ❑ FHA'/VA: Yes ❑ NoZT-__ TYPE OF`INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well---6 ------Dis#ane from foundation____ �-.--.M rial- CSW 1^ _r------- '�� No.of compartments-�-�____. --Size-�-�1Q_-X �_^_'Li uid'de th"_��2i..t-__ -_Ca acit 1200_ q p P y-- Disposal Field: Distance•from.nearest,well_, -:-Distance-from.foundation_----_1 -_-.Distance to nearest lot line---,1 -- ------ Number of lines------ ---------------------------Length of each line _ -Z -- --__Width'.of trench----- '� • Type_of filter mat ial.KIK _Depth•-of filter material"-"-�- --�_-------_Total length------ - -6_---------------------- t , Seepage Pit: 0 Dis#anter#o nearest well------- ----------Dista'n"ee from foundation_-______-".___.._--.Distance to nearest lot line---------__..".-. ❑ NumberIaf PIts__ -"--.--"---------_Lining material"_ -- --- - ---..Size: Diameter---------------------- Depth-------------------------------- Cesspool: y 't Distance from nearest well-----------------Distance from foundation------------------..Lining material_-:-_--_.----------.----.-----_----- 3� ❑ Size: Diameter--------------------------------------Depth!--------------------------- ----------------------Liquid Capacity-----------•----------------gals. 1 # .� Privy_: Distance from nearest well------------------------------"----.-_-_-__.�_-Distance from nearest building---f__.-__-_--------_------_-------------- _ ❑ i 1 4-- y Distance to nearest to line------------------------------ -- ------------------------- Remodeling -----------------•-----Remodeling and%or,.rapairing {describe):-7.A1_ t.<_. -----f_NS-TAA:1f _h--------t�------ 1V(----•-FQi1/�j O/V- --I-�J I_" l- £I S- -siii.-i�---, f a._ Mt ND-----7_M4T`- WAP-Gf�_:-N'C,�---------- s �x v- c ,F---- a_u , fir► n n -rte y _ iI hereby certify thatil have prepared this application and that the work will be done in accord ance`with'San Joaquin County ordinances,'iStafe laws, and rules and regulations of the San Joaquin Local Health District. {5i ne .. s ! 4 1` t - e� 9 ; _ -- --------- Owner and/or Contractor) BY= -' =---------------------------------------------- --------------�--- ------------------ an, ---—---------= (Title) r -- ot ------t-------------------------------------- -- -------------- plan, showing_sire of lot,,location of system,in.relation to wefls, buildirigs,:etc:; can be placed on reverse side]. - - 'Wo. N11 ,_ FOR DEPARTMENT USI: QNLY I j, t., APPLICATION ACCEPTED' � � ` - -- ---- - fJ_------- ---DATE-" REVIEWED BY-------------------------------- - -� ---- - ---------------------------------------L _.ba:_-ii ---------- DATE-_.-,.I'+r--------- ------------------ UILDING PERMIT ISSUED------------------ =---- -- I- -------------------- •- --------7-n--1-1----------------.DATE----------- t---------------------------------------------- & -------------- ------ - <Iterations and/or recommendations:--- �... - 1.± --.-.- p ___'_ .-._----_---"_-__ : ---- -----------5 --- ------- ---��-Eli----- --------- --------------------------- -- - { r ------------- - ----- ----------- -" ti - "'` ----------------- -------------------- FINAL INSPECTION BY:-."Y.11, ------ nom, Date.- -1�/_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 9-59 3M 3-'63 F.P.CC. CO