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FOR-OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - - ---------- ---- ----- r {Complete in Duplicate) J £4 -^'E - '' Date Issued Date Issued - - t._!__ ---- --. This Permit Expires 1 Year From 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 Count Ordinance No. 549. ScA 1 4 i JOB ADDRESS AND LOCATION �Y -: e ----- -- �y' v1- ---- i 1jR_ E_ l�IlSANj----------------- Owner's Name--- fz1111y----.--- ,2 /, -------- - - I -----' — Pi10RE........ Address---------..�T — `.._ ,Q1�-- --1� = ----- - _ Contractor's .- Contractor's Name 04-./1 %l� .-- -- - e1 ---- --- \-------•--•- --•--- Phone__ Z.7`_3�f�_f- Installation will serve: Residence Apartment'House ❑ mercia I] Trailer Colurt ❑ Motel ❑ Other ❑ Number of living units: __l___ Number of bedrooms -------- umber baths,_ .__/Lot size ----19-C,REE�_(�----------------- Water Supply: Public system ❑ CommunitWtrel-oS ❑ Priva R th to,Vtilater Tableft, Character of soil to a depth of 3 feet: Sand dy Loam E] Clay Loam ❑ ay E] Adobe E] Hardpan E]Previous Application Made: (If yes,dote....................) No New Construction: Yes 2 No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: �J (No sep+ic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well Distance from foundation____la_._._'Meteriel_ 11� e1 :__' Ifs . � -------- No. of tom artmonts______ _______ Size-#- --/y _ _ _ - ---Liquid de th----._ p ------- --- �- ---- - - q i? 1- ----- - - ------Capacity--- Disposa ie}d: Distance from nearest well-----k_P..._.Distance from foundation--_I�__._-.I]i ante to nearest lot line_!------ Number of lines--------- Length of each line__ fl:'J_I�-/.C7..Width of trench-..- _____________________e_. _ ;a Type of filter maferial_ _-_ 74��Depth of filter material_//_-__�I_�'Total length___ _,.._r_-_ - P SEE IWOT �i rruv• .t. Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------_......Distance to nearest lot line-_-----.---'____ ❑ Number of pits----------------------Lining material---------------------.-Size: Diameter-----------------------Depth-_------------------------------- _ Cesspool: Distance from nearest well -_'._-Distance from foundation____---------------- Lining material-------------------------_--_-_-_--_ ❑ Size. Diameter--------- i--------------------Depth--------------- ------------------------------`-----Liquid Capacity- ------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---:_-_____--_-----____-_-----._-..-_----. ❑ Distance to nearest lotline------------------------------------------------•--- ------------------ ---------------------------------------------------------------------- CASr 1 Rct.1 Remodeling and/or repairing -------d n- -T-M.-_Tt6HI`--l/N ---7 ---TlflV- ----[ J!1_ZQ-F_p 0 Awl- Tc� =-----0sK- = ------------------------ r------ --------------/16---'`---------.'-A ..-------------- NP _ -------- a` I hereby cert' y t t I have prepared this applicationat the work will be done in a r antewit San oac�T1 County ordinances, Stat aw and rules regulations of the San Joaquin Local Health District. 13ur— Nror HI'PRn1,tr---D t --r K 0 [Signed]------ ---- -�--- -�- ----- --- -- --- - - ------- ------- ------------------------------------- -------------------------------- (Owne /or Contractor) ---- (Plot plan, `showing ze of lot,-location-of system.in,relation to wells,Tbuildings-etc., can-.be placed.on reverse side).. _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------•--- ---------------- ----------••------•------•--•----------- DATE------- _ -- REVIEWEDBY------------------------------------------ -- -------------------- ---------------------------------------------------------- DATE-------------------------------------------- BUILDING PERMIT ISSUED------------------------- ------------- ------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------- --------------------------------------------------------------------------------------•------------------------------•------------------------------ ---------------------------------------------------------------------- -- --------------------------------------------------------------•--------------------------------------------------•-------------------------------- ry ------------------------1--------------.....--_...... - - yy • -------------------- 5-- -- s ........ ............. _.. .._..� -_1..._-_._._.____.__.._.._.._.._-._._._.____. FINAL INSPECTIG-N BY- - /�r�-- ------ --- ---1-`------ 7 Date-------------� .................il SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,CaliFornia Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-•63 F.F.CD.