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FOR OFFICE USE: -------------------------------------------------------- / _ ___ _________________ ______________----..___.______- APPLICATION FOR SANITATION PERMIT Permit No. ....�fP_�-Z._7 I'. (Complete in Duplicate) 7 I ----- ------ ----------------------------------------- This Permit Expires i Year From Data Issued Date issued ._--� _-- __- -3 OSg-roo-a Z 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. 54 : "` JOB ADDRESS AND LOCAT]ON-�� 2�A�-== a t Z44 /P",::: /jj --- ----------_--- -- --------------------------------------- -----------------------------------------------I------- Owner's Name----P_ M7)/ 5e ... ' Phone r _ ------------- Address--- A&C?_9 2l-SContractor's Name -- �4, � (r --A/ ........ -- •-•----- Phone, . _/ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living unitsi =:..._..Number of bedrooms ________ Number of baths ________ Lot size r ' _.__ _"-- ___________________.__ � L --- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table VAP- ft. � Character of soil to a depth of 3 feet: Sand ❑I Gravel E] Sandy Loam Clay Loam L] Clay ❑ Adobe E] Hardpan C]Previous Application Made: (If yes,clate-J-7-;5 ____) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer istavailable within 200 feet.) > Tahk: Distance from nearest well----------.------Distance from foundation__________________-Material_-__.._._._.______.______.-.-__---_._ ra No. of compartments-------------------- - ---Size-------•------------------------Liquid depth---- ---------------------Capacity---------------------- o i fd: Distance from nearest well-----------------Distance from foundation-__s__________._. .Distance to nearest lot line--------------- - A Number of lines-------------- --------------------Length of each line----------- -------±-------.Width of trench.------------------------------ - Type of filter material---------------_______.-Depth of filter material-----------------------Total length___-_-__..-____.___________.__----------- Seepage Pit: Distance to nearest weli0_j�------ Distan rom foundation__�4:_____.._.Distance to nearest lot line-_/d-__- f��( Number of pits.-__/__.___-_____Lining materialQ __...SJze:,Diameter___ -��_-.Depth........ Cesspool: Distance from nearest well-________________Distance from foundation------------------- lining material-_ .__.____.___________---.______ �- ❑ Size: Diameter-----------_--------------------------De th--------------------------------------------__ ---_.-Li uid Capacity_ P . - q --------------------------gals. II Privy: Distance from nearest well------------------------------------------------- from nearest building_a-______.-________.______--------..._--. F ❑ Distance to nearest lot line-------------------- ------------- ---------------------------------------------------------- F Remodeling and/or repairirig-(describe]:__:,!F-9'/9-/M/ --____/Q_________ ,S�f///�-_- JV /�� 1 / --------------------------------------------------------------------------------- --------------------------------------- --------------------•--------------------------------------------•----•------------------------------------------------------------- -------------------------------------' ------------------------------------------ --------------- ---------------------------------------------------------------------r------------------------------------ 1 her y cer 'fy that;) have prepared this application and4hat the work will be done in accordance with San Joaquin County ordinances, St to aws, and rules and regulations of the San Joaquin Local Health District. (Signed) 1l ---- ; ; {Owner and/or Contractor) - - - - (Plot plan, showing size of lot,-location of sysem.in relation tow s, buildings, etc., can be"placed on reverse side).- FOR DEPARTMENT USE ONLY ) r d_ APPLICATION ACCEPTED BY--- - ------------------------------------------------------------ -- DATE _,7_a-!7 G3 r REVIEWED BY - i ---• DATE •:' BUILDING PERMIT ISSUED-_-------------------------------- --------------------------------------------------------------- DATE Alterations and/or recommendations �---y-�----------------•------------------------------------------------------------•-------- = ---------------•-------------------•--------------------------I------ ------------------------------------•-----------------------•-------------------------------------------------------------------------- ------------------------------------------------I-------------------------------- ------------------------------ ---------------------------------•---------------- - -- ---------------------• ------------------------ F ------------- -------------------------_--------___--------------------------------------------------------------------0401 . FINAL INSPECTION BY: _' ------------- Date----- "�7"b SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haseltan Ave. r , '300 West Oak Street iA 124 Sycamore Street i 205 West 9th Street 5locklon,California Lodi, California Manteca,California -!FJ Tracy,California E5 9 REVISED H-59 3M 3-'63 F.P.100.� t 1 w„ • � 'f '