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a `. APPLICATION FOR SANITATION PERMIT Permit No. n (Complete in Duplicate) � I }}•l 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 made in compliance with County Ordinance No. 549. s7 0 OB ADDRESS AND ,,aaLOCATION----- ._ __��__�_---� `� -------M/�/ .1---------N---SIDE Qe= T-- Owner's Name--------VYQ-ID-DRQyQ_. ------.. NC:�--------------- ------------------------------------------ Phone-6 `�`�`1.��-�- Address---------- i_x_......1_1.9.12F7--------------- - r ----------------- Contractor's Name__.--------A-130-9J=------------------- ----- Phone-----------•------•---------- ------------------------------------------------------------------------------------- ------ Installation will serve: Residence MCj Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I-.---- Number of bedrooms __1____ Number of baths J_____ Lot size ------170--- ------ki------------------------ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [j. 'Hardpan ❑ Previous. Application Made: Yes ❑ No ❑� New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---`-------------Distance Distance from foundation__.JV-____._.__.Material-___-RE_vwv!PQ P_-_---___--. � No. of compartments_________�.___.____ _Size_ -----------------Capacity.�.,�K_��_Liquid depth _ _ _ Disposal Field: Distance from nearest well......!F"o----Distance from foundation 10 to nearest lot line___-.. Number of lines__________t_ _ _ _____Length of each line------ 1P------------_Width of trench___ _�_+�_1F----------------- Type of filter material___�0!_��.____Depth of filter materia_-_---_/-K-__---- Total length------- �_ ______________________ 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-------------------------------------- 0 ___.________- _______-❑ Size: Diameter------------------------- ------Depth----------------------------------------------------Liquid Capacity----------------------------gals, , Privy: Distance from nearest well-----------------------------------------------._Distance from nearesf building______-_______________________._______--. V� ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):----- (<1� --------.7_ 6__` a-----T-- .q- i-K-, ---------------------------------------------------------------------------------=-------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared thi a�plication and that the work will be done in accordance with San Joaquin County 1 ordinances, State,.lawss,,afid rules and: regulations of the San Joaquin Local Health District. (Signed'1----- r -------=--------------------------- --------- ---------------- -----------------------------------------------_(Owner and/or Contractor) By:-----------------------------=------------------------------------------------------------------------------------------------------(Title)------------------------------------------- -------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). z FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ZRAr _A---- ------------------ -----------•--------------------------- DATE-------- ---_4 - REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE---------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------f----------- DATE------------------------------------------------------------ Alterations and/or recomr�r eoations:_--'—HA!46rED--- 57PGS.----�M-------0L3------4:EA-5;A------------ ------------•--------------------------------- --------�-��vi--�-=r_o.�lFic._�,----- -�--i�Cr-�----t-1Fl��i�---��ttir-----�c�C��.-- �N-•----�a�`---��-T-E-I-��-------P_��__P�1[`�`" LLQ - :4C /-,( ._.. -l- w I T 1 G L�' ------LN------- : 1`}'[-- --------- C ------l-i/ t c- ol�� Qr-1 till?5 a — j'�3Ec _ -1~ tlA -2i Says i4^� a� ►�T fi � - T-- -I5------ FINAL INSPECTION B :. r -------------------------- Date- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5 9- 2M , Revised 1-57 F.P.CO. s