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---- ------ - ----- ------------ --------------- --------- APPL.ICAT169 FOR SANITATION PERMIT Permit No. _Z-7J9_Q,�' -' (Complete in Duplicate) This Permit Ex fres i Year From Date Issued 4 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit.to construct and install the This application is made in compliance with County Ordinance No. 549, c work-herein described, w 7� - JOB ADDRESS AND LOCAT N_ Owner's Name-- '- - -•-f--�--edA7�-�----------- r T � -----•------------ I ------------------------------' ................................ ----- J'4, Address---- •&7-�d------- 1 fPhone. f - — a. ---------------------- •-------•------------------------------•- : Contractors Name--- ---- __ _ ___ _____________ _ ____r__ ______ ______ Installation will serve: Residence Apartment House ❑ Commercial PhaneA[_______`---9G07 m. Number of living units' J---- Number of bedrooms _ ❑ Trailer Court ❑ Motel ❑ Other ❑ �` 'Number of baths -_-- Lot size IAP----4`Gp� Water: Public system Communit system ------------------------------------ Supply: Y Y Y ❑ Private ❑ Depths to Water Table -,C4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam❑ Y + ❑ Clay Loam E] Clay ❑ Adobe Hardpan ❑ Previous Application Made: 0 yes,date--- -__-I No Z 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-from foundation------------------- Material El. No. of compartments--------------------- - -Size. ----• --------- -----------Liquid depth-------------------- Capacity.-.- Disposal Field: Distance from nearest well. -` ` Distance from.foundation---- r's'r-=---.Distance to nearest lot �- N PNumber of lines---/--------------�--_------ -Lep th sof each line----=_L,f-D-'- - d ----- Type of filter material,N4� -Qa[/( ----Width of trench.-.-_.�_-r_ r 41 "r De th of filter material-_---4.............. Total length---.QLD°__,_. _ t _ �� eepage Pit: Distance to nearest well_--. _U��------Distance from foundation__4� -•-____.Distance to nearest lot line _S_-D Number of pits---.l---__-_____--Lining material-- .:_. < Size: Diameter-_ �` ��N°'` ' I y "f 3-1----------..Depth--- ------ Cesspool: ` , • E3� ❑i? Distance from n;arest well----------------f.Distance�from foundation_--�_'___.__ ___- Lining materia!__------__ Size: Diameter---------------------- `" f Depth- --------------- `_----------------------- ---Liquid Capacity :gals. M Privy:- Distance from nearest.well__________________ __ ` '- - --- ------ Distance from nearest building ' r , .✓ g to nearest lot line-__-- F ......� ------- ---------------------------------- --------- ----------- Remo eling end/or repairin ( escribeJ:'__--__--_ r er r ;. r -.�-------=--'---------------- - ------------ -----------------------------------•------------------ ----------- -------------------------- --------------------- - ------- . I --- ----- ----- ---- - - ------ --•--- ----- ----- - - _ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to lawst and rules and regulations of the San Joaquin Local Health District. (Signed)---- f _ ------------------------------------------------- ---------------(Owner -------� -�- -- -•- -- - - -- - Owner r Contract -- and/or or) ----------------------------------- Title---- � �. (Plot plan, showing size�of lot, location of system in relation to wellst buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY- _ _ _ DATE----_ ---- --- ---------- -------------------------- REVIEWED BY------------ �-------• ---------- ------- - - - ------- - --------�--- -------- --------- -- DATE BUILDING PERMIT ISSUED - ------ ------------------------------ --------- DATE--------------------------- -----------AE#erasions and/or recommendations:.-_��-��__ -_"" '� •------- ----•--- --- � ------------ ------•---------------------------------------------------------------------------------- I-------------------'------------------------------------------.-- ---------------- FINAL INSPECTION BY:. / /� u _ ---- - .--- --- �------- -- Date-- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E,Hazelton Ave. 300 West Oak Street i 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED 8-59 3M 3-'63 F.P.120. ar