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FOR OFFICE USE: ------------------- ----------=------------------------ i�a --------------------------------------------------------- APPLICATION FOR�:SANITATION PERMIT Permit No. _------------------ - ---- -------------------------------------------------- (Complete in Duplicate) w F. � ---------------------------------------------------1_..__ This Permit Expires l Year From Date Issued ' bate 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 incompliance-with,County Ordinance No. 549. C��`t�_ 030-1- ' JOB ADDRESS AND LOCATION-- -- ------�C Owner's Name------- ---a, _,ioamm�j:.t------------------------------ �--------- ------------------------------ Phone---------------------- ------------- Address---- -._,�4 ------ `S/1.��' { ry- f --------------------- Contractor's Name_------XX9 __,0_71_e e-I;,;;" - --------------------•---•----------- ------ Installation will serve:,t Residence Apartment House ❑ Commercial E] Trailer Cdurt ❑ Motel ❑ Other E] _ Number of living units: __/__ Number of bedrooms _' _. Number of baths Lot size ?cz:�� - ------------------------------- Water Supply: P tbrlic+sysfem-- ]""Community system'" Private ❑ Depth to Water Table q �ft. Character of soil to a depth of 3 feet: Sand ❑ Gravell0 Sandy Loam [Clay Loam ❑ Clay ❑ Adobe Hardpan [�(AL Previous Application .Made: (If yes,date___________________) No Z3"� New Construction: Yes Kr jo ❑ FHA/VA: Yes E— No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septi tank or cesspool permitted if public seer is available within 200 feet.) Septic Tank: / Distance from nearest well_./ -.Distance f om foundation---A?---------Material al_9.15�les L_0 /!_ --_ i No. of com artments----- ---- ------- Size q P -- --------------.Capacity,_s�- p � v2- - ---- �,�- _._ ��Li uid de th__-�'" -- DO----- s r. Disposal Field: Distance from nearest well _ P-_._,)ist—.4e from foundation__Wd_________Distance to nearest lot line._t�_r_______ Number of lines_I:_._s ______/ Length o£ each line4 _ ____________.Width of trenchr°�__ _____.__________-_______ - -- sy�' Type of filter material /-, 0 __Depth of filter material_ __- Total length_, Q _______-c___________________ See a e Pit: Distance to nearest well--4 s�$___-_-'Distance f om f undation___ q p g � y� - _.__.___.Dist nce to nearest lot line�4__:__. 11 Number of pits..%_a ----------- material_ __-_Q _____Size: Diameer_ __ p ' 2CX _-De tnf `' .1K IV Cesspool: 1 Distance from nearest well-----------------Distance from foundation-------------_____Lining material-_---------------._________________- ❑ Size: Diameter-�J- -------------------------------Depth----------------- -------- Liquid Capacity gals. Privy: Distance from nearest'well,_____.________}________________________ ___Distance from nearest.bui#ding-------<<___.------------------,___-____. Distance to nearest lot lin-e4 --t"- ----------- -------------------------------- - - Remodeling' and/or repairing (describe):--------/Le_ Tr----- ---------- ---- -------` ----------------------------- • --------------------------------------------------------------1----- . ; t -------------- 1 hereby certify that I have prepared this application'•and'mat.the-work will-be done-in-accordance,with San Joaquin Count ordinances, State laws, and rules and regulations of the Sari'Joaquin Local Health District. .7 ,(Signed- --- `r � /L� E ----------- -- �_--------- - - -------- ----------------------- r Contractor (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 - . f E APPLICATION ACCEPTED BY-- - - -------------------------- DATE---la-7:--- ------------------------ REVIEWED BY----------------k------ _`-----;_ t ? -------... DATE------- -� W -----------------------------------------------------, ___T__________ _____-___ BUILDING PERMIT ISSUED--------------------I-----------------------------^---------------------------------- DATE - -- -- ----- m - ------- Alterations and/or recom-endations:- ------------------- - _= ! --_=:..:..-- s p ____' _.._____ _________________________ ___________________________ _ __-_. __._,.__ _ ---- - _ _----"--- ---- Y ____ _._ -.__- i - - ---- - ---- - -g..�9.�---- -- ------ - --�,.�J -.:----- - --dam..--�s►.a,��--------------- -- - • . -------------- - ---------------------------------------------------------- -------------------------------------------------- ------ ------ ------------------------------------------ FINAL INSPECTION BY:-, �,r,.� ---- ---------- Date-----;L - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ffa:eiton Ave. 300 West Oak Street + ;"y';724,,Sycamore Street205 West 9th Street Stockton,California Lodi,Calif nod Manteca,California Tracy,California 99 9 REViSEO 8-59 3M 3-'63 F.P.CO.