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� ��• •�v.a�: 0 / r �'�---ter.. 11 --_. ------- ----------------------_-._ APPLICATION FOR SANITATION PERMIT Permit No. - S --------------- --- ------------------I'•-- --- ..... {Complete in Du licate . This Permit Ex ices I Year From Date Issued~ Application is hereby made to the Son Joaquin Local pate Issued 4 1 Heal}h District for a permit to construct and in the work herein described. This application is made in compliance 'wit Count Ordin e No. 549. JOB ADDRESSFAND 1 nTION ° c4 � �^ i Owner's Name-------- - = - ---- -- ------ � p -•---�- - �- F ------' - -------------- ------------------------------------------ Phone IV----_..... --'Address. Contractor's Name ---------------•-------•-----•------------- ____•-___•_ - --- - ---•- Installation will serve: Residence - --.---- - ---- -----------------•-------•--•---------•------•-- Phone-•----------•-----• • s[�'Apartment House 0 Commercial Number of living units; __/-- Number of bedroom ❑ Trailer Court E] ----•--•--••-- MoteOther ❑ Number of baths_- Lot size l ❑ Water Supply: Public.s2� I stem � ------ -- •- __ Y ❑ Community system 2 Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand -- ff• ,�� ' ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayR Previous Application Made: [If yes,date--------------------] No ❑ Adobe 02"'Hardpan ❑ I '* TYPE OF INSTALLATION AND SPECIFICATIONS: Ne"' Construct Yes [ ❑ FHA/VA: Yes�No ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet, y F Septic T Distance from nearest II_-._. ! Distance from foundation a No. of compartments_-_� ---------.Materi i______ -- -- ---Size -�C �►y 4� lea-r_Cd- -moo _Liquid dep#h_.-__ • Disposal geld: Dis#ante from nearest well_ f �"`� Capacity--� C Distance from foundation-�---P--Distance'to•nearest lot line, ___�____ Number of lines-------------�-____- Length of each fine.�j Type.of filter mafieriaL_ l f '� Width of trench-- __V ' " -- --- -_-'Depth of filter,material. -- - ---�i-----Total len fh- Seepag Pit: Distance to nearest well ___--_ pis#arece from foundation_ g ----------------------- Number of pits___-f_ 6-------•.Distance to nearest lot line_ -� { . �I ------------ Distance materialYQ�.�--Size: biometer------ �.--- -J--•-- -- Cesspool: Distance from nearest well_____-_______ �- -Depth-----e7-�' - Distance from foundation_-------------------Lining material___ __ _________ Size: Diameter------------------------- Depth ----------------------- a - Liquid Capaci#y.*-_j-----------------'-- ' Privy: Distance from#nearest_well----------------- -------------- gals. ❑ Distance to nearest loft line____.._.___,.____. ---Disfance.from,nearesf building----------------------------------------- --- ---__---------- . > ----------------- _ -•--------- �-'--�- - Remodeling and/or repairing(describe)----------- ------- ----------------------------------------- - - g pp t=+ ---'--�`------=------ -------------------------------------------------------------- p P ordinances,hereby If ws, d h rule' an re to f oa fG+��Say�a�a} the �"ork will be done in accordance wits, San Joaquin County Joaquin Local Health_ District• q i (Signed) ----------- BY:----------- _ -2 - -- --- -- - .... ,_------- - ,^ caner and/or Contractor) {Title) .. - (Plot plan, showing size of , t, :cation of system in relation o ells, buildings, etc., can be . laced on rev P erse std FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY " - , --- ------------------------------- REVIEWED BY -- ----------------------- DATE_.------ I ----------------------------- ............................... "'- '."-"' ..-' BUILDING PERMIT ISSUED-------------- DATE-------------- -- , Alterations and/or recommendations:__.r . ' ---------� - �- -- -- DANE ----------------------------- - --•----•- ----------- ------_- ------------------- --------------------------------- �1�--- --------------------------------------------- --------- ----------------- ________________ _ ___._-__-._-_-_--------._-----•--_----- ------------------------- _____._._____.._ i { -------- -......------------------.-----------.---------------------------------------------. -......� ---------------------------------- XQUIN le,- -------------------------`--.-.. FINAL INSPECTIO Date----.—---- - .. ---------� ---- II SAN JO AL HEALTH DISTRICT e 601 E' °1OitOn Ave. is 300 West Oak Street x"-124 Sycamore street' Stockton,California Lodi,California _E .'-. 205 West 91h Street Manteca,.California E5 9 REVISEf] 8.59 3M 3-'63 F.P.CO.� f Tracy,California