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FOR OFFICE USE: -� z ------------- ------------------------------- ----- ---------------- ---------- --------------------------------------------------- .____--__ -------------- APPLICATION FOR SANITATION PERMIT Permit No. . (a_ r-' (Complete in Duplicate) =----------------------- --------------- "' Th'is Permit Expires 1 Year From Date Issued Date Issued - " :_ .Z Application is hereby made to the Sawn`"Joaquin Local Health District for a permit to construct and install the work herein described. This application is,ma a In compliance with Counfy Ordinance No. S49. �p� ._ �gp -VC 7So r TkAy r'�-J y9 15/ [)11-) ; / I JOB ADDRESS AND LOCATION---.1-11 R �- �� H -----. ---------��----A1-------fEio-•----.��_t Owner's Name----------- � _ '_ -.{ € H NIE!_-T! Phone if I f Address �L� � --•------- - ----------------------------------- Contractor's Name__IRNTEf3--• Pel-lei--=-------------------------------------------------------- Phone. Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑Motel ❑ Other ❑ Number of living units: Number of bedrooms _ -__ Number of baths k-_ Lot size ___1v /fr� _ - ---•-----------•--------------- Water Supply: Public system [-I Community system ❑ Private Fr-'-Depth to Water Table Character of soil to a depth of 3 feet: a Sand ❑ Gravel ❑ Sand Loam Clay L ao m Clay.[],Y ❑ y ❑ y.❑, 4Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date�__.__ __ --------) No New Construction: Yes o ❑ FHA/VA: Yes ��No ❑ TYPE,-OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �CP I1 t Septic ink: Distance from nearest well___�~ ___-Distance from fou-ndation___ . _______ _.Mater _- No. of compartment ___.__�e - ------Size-�-/Y�QrY ___Liquid depthI is ----------Capacity-2- Disposal apacity_ _p --- Number of lines__ ___ ___�._ _ ��+ J�* P } ells ._Distance from foundation.__.,/&___----Distance to nearest lot line-=.�-_____..'� pis oral Field: Distance from nearest we __ ___ -----Length of each line------f 0-------.----Width of trench- �g--11------------- rs Type of filter mate�ial_�"�4�i+�--_Depth of filter material__,-.--_Total length-------- -: -0 --__-�^� It Seepage Pit: Distance to nearest well________ ____ _____Distance from foundation_ - _.__._.._Distance to nearest lot line_______.___._____ ❑ Number of pits--------- ----- ---- inmg material.---------------------- e biameter----------------------- r Depth ------------- --------- j! Cesspool: Distance from nearest well---- _______-__-Distance from foundation__-_ -----___.Lining material --------- 7 Slze: Diameter =------�-------.Depth--------------------------- --------------__Liquid Capacity-.------------------------..gals. Privy: Distance from nearest wet!__ -- _______________________________!Distance from ne"'arest building------------------------------------------ ❑ Distance to nearest lot line. _ `" _.--------------_-.---____ SCS Remodeling and/or repairing (describe) ARE - ------ W = ------ ----------K- ------ �_ T 1--- ---- - — _i- ---._�-- - --- .� r --------------------------------------------- - = ' -------------- ---------•---------------------------------- ---------------------- ------------------------ I hereby certif that I have prepared this application and that fhe!work will be done in accordance with San Joaquin County ordinances, State ws, and rules an re ulat' ns of the San Joaquin Local Health District. (Signed) . . . �� c"` '�`� --------------------------------------------(Owner and/or Contractor) ------ --- - ------ -- --= 1 - -- - -== - - -- -_-- •_-------------- --- - - ------)Title)------ ----------- -----.----------- ----------- of pan, showing size of lot, I ation of system in relation to wells, buildings, etc.,,can.6e.,placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------------- DATE- -- �-1 = DBY --------------= - '------------------------ - DATE----- -- - ------------ �--------------•------- ---- BUILDING PERMIT ISSUED • ------------------- -; DATE------------------------ Alterations and/or recommendations:_____ ---------•----------------------1=- {0-------OF �t1� �� -- f3. :H= CD_U'_ I I� = .......fl+ j>' -------------------- ``7 - -r�=�_ .ct-- ---------------------- = ? --- - ----------- ---- --- ----- ------ t� FINAL INSPECTION BY:. ry-� -- -------- - Date--------- } SAN JOAQUIN LOCAL HEALTH DISTRICT 1 ) 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street l' ' 205 West 9th Street J Stockton,California Lodi,California Manteca,California 1 Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD. - f'L