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�- OR FFICE USE: 1 - : 4- --�-_ ._ 'APPLICATION FOR SANITATION PERMIT Permit No. ../"7_-U_�' ------ � � �� i (Complete iDuplicate) . tom/ `/ to rl Z �� ompeenupcae ., � Date Issued /-- ----- _x , / C�.-. Is Permit Expires 1 Year From Date Issued -�� _ Application,is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applickion is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI N------------- � . --------- ----- --------- -r�-� ✓t d•----- Ly" 1t -- Q-.S - Phone -- IIS Owners Nafme________-___ __.__.____ Address-----I�I� -----------� -----------------------M�------------------ •------- d Contractor'! Name----------------- Pha li-:a o e.. Installationlwill serve: Residence ❑ Apartment House ❑ Commer;I-p Trailer Gourt❑ Motel ❑ Other / � 1 e .. Number of living units: _ - Number of bedrooms L Number of bhp^ ._'Lot size _._____________________________-_--_-_-- Water Supply; Public'system ❑ Community systeem,E] Private to Water Table\&�7 ft. Character of soil to a depth of 3 feet: Sand ❑/Gravel E] Sand .L� ❑ Clay loam ❑ Clay ❑ Adobe 16- F] Previous Application Made: (If yes ciat ________..) N New Construction:. Yes' iO Eq FHA/VA: Yes,.❑ No ❑ TYPE OF INSTALLATION"AND SPECIFICATIONS: �t ` (No, eptic tank or ce'sspo'ol permitted if public sewer is available within,200 feet.) t13� -Septic n F1 D:lance from nearesv�ll-_s� ------"bistance,from foundation:f.�p__ :____.Mate�i�l1_...o /_"G � Caacit //�7:_._.____.___"._.._.. N of comPartments_._ o --------Size_ ' 7UgdiLldepth --- Q ." Disposal 'Distance from neart wel � ___�-Distance from foundation--,/ bistance to nearest lot line_"- .,-. Number of lines-----_. __________�_____________LengthM1of each line 3 -_Il1A O4 -L4-a".Width of trench._._____._. _____.._..._________"__�i ` ,Type of filter material__-A__P4n.�Qepth of.filter materiaf'r_ �-_._._Totaf length_", Q_ ______________________ e r t' % i �.__-Distance from fo dation___� 7 Distance to nearest lot line_�!______ a Number of. Its.__ z Lin"n � /"""__"_--""_-_� t M pi t WBeepa it: �Q�fan,, 1,eare t wellk. 4._Q__:_. _Size: Diameter__. .3_____._.___-De th__�„�__ _ _ ' material_ ,v�__. �_ p yCesspoof: Qistance fiom nearest wel ______________Distance from foundation--------------------Lining _ ❑- t } ; material__.._.____-_..__________________ Sze: Diameter_ -- - -- --- Depth ----------- ------------------------- --------- --Li Liquid Capacity ------------------- ga•ls._.. ' t Privy: :'. Distancefrom nearest well-- --------- __________________________Distance from nearest building------------------------------------------ El '- Dismncetto nearest lot line-------- ----------- ----------------------•--------------------------------------------------------------------- -.... Remodeling and/or repairing (describe):_`------ 4: 7 -------------------------------- ------------------UIIIIhhN-------------------=- ------------------------------------------------------ ----------- --------- - - --------. - -------4--- _--------------------------y- _ ------ �__________________-II�__N{_________ Y_..____________T_ .__�_______________-_________-_.--___________.________________________________ _____-______-__________-_--__.____________.._-___.__ -------- I __.._ Hereby cer#ify a ave pre'p'are this application and that the work will-be don"n accordance with San Joaquin County ordinances, State`ia and 'ules and eguI ions of the San Joaquin Local.HeaIA District. ---- -•- ---- ---- ---- - -- --- -----. -- ----- ------- - ------------------- Owner and or Contractors (Signed).., . BY:II-' ~(Title) -------. (Plot plan, showing size of Flo , to ion of system in relation to w ildings, etc.,.can be place on reverse side). FOR DEPARTMENT USE ONLY �. APPLICATfON ACCEPTED BY'.,. : 's -mss' DATE. " 1� f ,REVIEWED! BY------------------------ ---- -- -- /r DATE---------------------------------------------------•------ 8UILDING1PERMIT ISSUED,_ ��__:__ -- _______________________----_-- - --------------=�'------------------------------------------------------------------- DATE.---- ------ Alferations.and/ r rec mm ndations F ' r -- Ir --- - -------------- Y �p �� /J�yy–�—� - = -------------------------------------- - -------------`'-=----._... _....---- �.----------------•-------------------------------------------------------------------------------------------------------------------- ---•---- FINAL INSPECTION BY:.------ /.G ------ ------------- ----•-- ------- Date-------- 6=447�- ------------------ ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. � 300 West Oak Street 124 Sycamore Street 205 West 9th Street SII r P Stockton,California 1 Lodi, California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3•'63 F.P.120. a