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FOR OFFICE USE: ------------------- / APPLICATION FOR SANITATION PERMIT Permit No. ..../ ---- --- --------------- ------------------ ------- -- (Complete( omplee iin Duplicate] /.d J _ Date Issued -------/:�---6� ----------- - + This Permit Expires 1 Year From Date Issued A p i location re made in compliance San Joaquin-Lo'c'al Heslth-District for a permit to construct and install the work herein described. A location is hereby made to tli PP iance with County Ordinance No. 549. Aft JOB ADDRESS AND LOCATION — -'----•--- - ----------- - ---- -`- - - ------------- Owners Name_______________ ___ k- •tom- r- _ _1 - - -----: Phone_. .. _._ �� // Sf/t Address 75 �� _: -- .lLi� t ;{ / lroEaT Contractor's Name--•----------•---------i�-L(�k__/ir � = ' ------. Phone f1 ; Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._l__,_ NLmber of bedrooms _-�umber of baths __�-____ Lot size __ __ -.-- ----f �------------ Water Supply: Public system❑ Community system ❑ Private%, Depth to Water Table -" ft. Character of soil +o a depth of 3 feet:,, Sand ❑ Gravel ❑ `Sandy Loam ❑ /Clay Loam ❑ Clay ❑ Adobe•®* Hardpan ❑ Previous Application Made: (If yes,date_------ ------------- No�M. New Construction: Yes[] No �� FHA/VA: Yes ❑ No, TYPE'OF'INSTALLATION.-AND SPECIFICATIONS: r ,ot xr (No septic tank or cesspool permitted,if public sewer is°available within 200 feet.) p IT .� _ Distance from foundation Material-------------------------•---------- Diffance from nearest f f k p Liquid depth----------=-------------- Capacity.---------------------- Se Ow�t 5 k j')� No.of Vicom artments- well------ ----------Size------------------------- Disposal Field: Distance from nearest well_._-__.---------Distance from foundation----------------____Distance to nearest lot line___-____________- �,.❑gXCs}z`PJG•- N lmber`of lines 4__----•-------------------------Length of.each line-------------------.....----Width of trench , Type.of_filter material--------------------------Depth of filter material --------- -- -Total length-----------------:------------------------ W `--___.Distance to nearest lot line_6.�________- Seepage Pit: r Distance to nearest-well__/fQ_---------3Dlstance from foundation-___ __., --+ r r r . Q. Number of pi}s _^A f�- ---Lining material_R[2_C! ------Size: Diameter_-. 3 _-_...___.Depth___. � ---------------------- -11� } i Lt, i. Cesspool: Distance from nearest,welL______________'Distance from foundation___.------__.__---:Lining material__.__________________________._____ ❑ Size: Diameter_-41------------.--------- --------1 Depth---------------- ° Liquid Capacity gals. F I Privy: �: �,. Distance from nearest well'-----------------------------------------------Distance from nearest building----------------------------------------• i ❑ Distance to nearest lot line 5--- -- ------------------------------ ------------ ------------- -------•--• -------- -- - - ----------------- ---------- Remodeling and/or repairing (describe):--- Y/5.- C-: A___ =` — .cam-------- ----- ' ------ Remo ----------------- ------------ - = -------------------------- - l • t t _ ______________________________________________________ hereby certify that I have pre'pared ------------------------------------------------------------------------------------- -------------------------- ----------------- - E _ y y p p his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andrules and regulations of the San Joaquin Local Health District. a g (Signed) --- ------- -- t� -----1=- -----------�-- -- - ---�--------- ---------------------'--------------- . (Owngr and/or Contractor) + :l � �� / rte- v___ Title !_1 �- -a!!, (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 APPLICATION ACCEPTED BY- `'= = '' -------------------------------------•--- bATE, CJ 3 ------------------- I - .-. . ------ DATE-------- ------- REVIEWEDBY------- --------------------------------------------------- - ---- - ------------- ---- -------- BUILDING PERMIT ISSUED--------------- ------------= - — - DATE_ l ---------- ---------- I - Alterations and/or recommendations:.4 --- ",2_ _"-- -,•-----------------------•--•----•-- ---- --------------------------------------------------- ---- ---------------------------------- ---------- ----------------- ---------------------- ----- ------------------------- -------------------------------------------------------- ----- ---------•------•---------•--------•------ I ----------- ----------- ---------------------- ----------•------ ------ 4 ., - __ _ - ` FINAL INSPECTION BY;-. -- - -------------- --- ------------------- Date 1r� '`.�. I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hat:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r ES 9 REVISED 6-59 3M 3-'63 F.P.CD. r