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FOR OFFICE USE:- /q __ q _._ L__.__"________________________. API,ICATION FOR SANITATION PERMIT Permit No. ...,l.lD.... ------------------------------ ------------ (Complete in Duplicato) 2 V -.--- This Permit Expires 1 Year From Date Issued Date Issued --- %------ y 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. JOB ADDRESS AND LOCATION------_'------7=3I.............e /yKI / -------------moi one- Address �.l. Owner's Name-------iAJAV . CR.:M6------------------------------------------- -------------------- Phe_ Address------------------------- e7`-sw �) 't ° � U ---------------------------------------•--------••-•------ ;011 Contractor's Name------ /tk4 �------//V -----------------------:--------------- ---------•------;------•--•---------- Phone_//ep l Installation will serve: Residence ❑ Apartment House❑ Commercial �' Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ---------Number.of.baths __ _,_.Lot`size ___/,x ___; �____-_ t Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table A0- ft. a - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay'Loam ❑ Clay [j Adobe ' Hardpan ❑ Previous Application Made: (If yes,date-------------------_) No X New Construction Yes X No ElFHANA: Yes E] No,M TYPE OF INSTALLATION AND SPECIFICATIONS: - r t r. y.. (No septic tank or cesspool permitted if public sewer is available within 200 feet.). Septic Tank: Distance from nearest well, W45'--Distance from foundation---- 0."_--_.-_.M efiaL_ c?/y(W " _.-_______.___. ®' No. of compartments-____-_1-------------Size'3_X•5__'_A.. Liquid depth__S�Y-------------------Capacity.e _Gi Disposal Field: Distance from nearest well i-__Distance from foundation___-h!0_-------Distance to nearest lot line_-._1� -'__ k - ' Number of lines_____________ __ -----------Length of each line.-.-____-----__- Width of french-------------.2 ---___ Type of filter material___ -----Depth of filter material-------/ ........Total length--------------------- ��__--____ Seepage Pit: Distance to nearest well__A'9' '.AC___Distance from foundation___--f '.f__-..Distance to nearest lot line_-_�-�--_- Number of pits.........I----------- material_-----__Size: Diameter.-------t -----Depth___.."___... _`----___- Cesspool: Distance from nearest well--------------_Distance from foundation_-- ------------Lining material___._--______________-______ t ❑ Size: Diameter-------- -- -------Depth-------------------------------------- -------------Liquid Capacity- --------------------------gals. I Privy: Distance from nearest well____ _---_-__---------------_._-____-Distance from nearest building_-------______________________--___--____ ❑ Distance to nearest lot line----------------------------------------------- -------------------------------------------- Remodeling -----------------------•------------------Remodeling and/or repairing (describe:__-1 3 J} 1 / 4— -.----�� 5%�`� ----.--�e_r------ f 1 1=, ' ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------------- 4,4 - _ (Owner and/or Contractor) -71 B G s7"�C------------ t rifle r-------------- �' . n-114-u--e- -------------------- [ ) - (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY--------- --- ---------- DATE REVIEWEDBY-------------------------- ------------------ --------------------------------- --------------------------------------------- DATE----------------- BUILDING -------------- BUILDING PERMIT ISSUED------------------------------------------------------ - t ---- DATE------------------------------------------------------------ Alterations and/or recommendations:---Z. --------- 2,'� �------------------ ---- - - - ` ' -•----------0,__-- :tr-S----------------------------------- --------------- ----•-------•--------------------------------- --------------------- ---------• - -•-----------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------•-------------•------------------------- ----------------------•------------- -----------------•- - ----•----------------------------------------------•------ --------------------------------------------------------------------.- -------------------------------- ---------------------•-------•- ---------------------- ------------------------------------------ T .. FINAL INSPECTION BY: C- ` - ---------------------------- Date---- ` - 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVFSED 5-59 3M 3-'63 F.P.CD.