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+' FOR OFFICE USE; ------------------------------------------------------- ---------------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. ,L.7. _-_ ------------- -------- (Complete in Duplicate) It ] Date Issued Application is hereby made to the San Joaquin uPeLoctal Health Dit Expires I Ye+ From ©ate Issued pp q `for a permit to construct and instalfthe work herein described. This applica+ion is made in compliance with County Ordinance�No. 549. JOB ADDRESS AN OGATI64__,_-- _ - _-- Owner's-Name-_ _ t f --- -- --------- Addresso--,,.-�--t -- ----- --- Y r i! 1 -- ----- ----- i Contracto'r'sNa ---- S.� ' III _V Installation will serve: Residence [1 artment Hose ❑ Commercial railer Court ❑ Motel ❑ Other �^ y t 0 s h ✓� ` Num ber of'livin units: ___ _' Number of bedrooms _______. Number of baths )-Lot size ____-- R �. # g J :--------------------•- Water Supply:- Public system 0 I Community system ❑ Private Depth to W er Table 5- ft. Charactkrof soil toas depth of 3 feet: Sand L] Gravel Q Sandy Loam Clay Loam ❑ Clay ❑ Adobe E] Hardpan [3y , PreviousiApplication Made: (If yes,�date-_----------_______) No R2-""New Construction: Yes 23- (7] FHA/VA: Yes E] No TYPE OF�INSTALL�ATION AND SPECIFICATIONS: r Septic (N? septic to"k or cesspool permitted if public sewer is available within 200 feet.) t W i Distance from nearest'well_____`.-__-[___rDistance from foundation______________------Materia L_ . No. of coin artments----� _-Size____-•------------------- '� ' # � P � - - ---5�- -------Liquid#depth -------------- ---- ---�_Capacity---/-1-10,49.--- j Disposal FieId Distance:from near }+ ell:__�. ..__ .._Distance from foundation'' _____..._.Distance to nearest loth' Numbeof tins=___! .-_ ___ Length of each line" _ '_f _____._��__fWidth of trench__ r Yom' � - -- T e�of.filter materia yp ____._ .__-Depth of {alter material_____ _ Total len +hrZ '�_ V V. Seepage Pit;- Distance nearest well_____________________Distance from foundation------------------- to nearest lot ine'TR.Q �.� � .o � , ❑ Number'of pits-------------- -------Lining,,4ferial---- ----------------Size: Diameter-----------------------Depth--.....�--- ----- --------- 0 Cesspool: 5izeaDameter_n++"�- t}Well -----Distance from foundation---.____: �ilnund Capacity-.tk -----__--als. r 4 a ------ ---- g. qI .,...�- rt, w ar. ., I Privy Distance ffrrdm nearest well ______________________________ -- _Distance from nearest building______ ___ _ l isfiance ton est lot line. ---------------- 4--- --------------------------------- - ------------------ - Remodelir:g and/or repairing (desc be)=------------- - - �. -�--�-�-A---------�------ -- -- ' ------ ----- - � A ti f---- ------ -------------- ------- --- -- - ' 114. . i --------- -- ----------------------------- .. =^= ------------------ D k f�ereb certfy .that I hare'prepared this applica}ion and hat the work ill bed a in accordance with San Joaquin County ordinance;, ft o I lawsoad rules and r uletions of the San a ca ealth D' tract. (Signed) - --- -------------- -- ---------------- r Contractor) 1 - $ ---------- - Title - --- :at---------------- (Plot plan lshowing�size of lot, I cation of system in rel atia wells,.buildings, a ., can be-placed on reverse side):* FOR DE ARTMENT USE ONLY ' -- --------------- DATE---------- APPLICATION ACCEPTED BY-----=_f r_- _� C1=-----------=--=----------------`------------------ - r REVIEWED By --------------------------------------------------------- DATE-------------------- BUILDINGPkMIT ISSUED----- '-`4--1----------------------------I---------------------------------------------------------• DATE---------------------- --------------- Alterations and/or'recommendations--_-_-_-_-._.- --------------- ------------ - ---'""------------ ------------------------------------- ------------------ ----------------------------- --- ----------------------fn~ �" = ------------------------------------- --- -------------------------------------------- -------------- ----------------------- ------- �' - -- ----------- ------------------------------------------------------------ -------------------------------- - -- -- ---------- - ------------- ---- ---- 8 FINALAINS`PECTIO - Date------ �--- � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California A Lodi,California Manteca,California Tracy,California y ES 9 REWSED B-59 3M 3-'63 F.P.Ca. i J