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FUROFFICE-USE: .._•____•----------'------------------------------------- .. -------------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No: 1-.fj-..Z21,_ - (Complete in Duplicate) / ,` This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to,the San Joaquin Local Health District for a permit to construct and install the work herein de cried. This application is made in compliance with County Ordinance No. 549. I pp/V JOB ADDRESS AND LOCATI N._ _ . — srA �� --- 9 F� QN IA. .._.® !._.__ _�r-�-- �---eq�.q------Ackr . �' Owner's Name_-=- -AR�Q'�"_--••-�1&�M=.......C •J,------------------------------ - -- -------------------- -------- Phone------------------------------------ Address------..... '� r CC11 � r----------------- � a .» -. Contractor's Name---:-==• -?� ,.• - ----� �------------------------------ - one Installation will serve: Residence Apartment House ❑ Commercialy�Ti�eiler"Court ❑,_Motel=❑7Other [J Number of living units: _� ber of bedrooms`_-Nu`mbero _baths ___lLat size .__�S �� r _ -,,�,- .� �,,... ---------- --------------- Water Supply: Public sys�e� (� Ctimmunit ystem Ej-,pivate, Depth to Water Table _ ft. Character ofysoil't a depth of.3 feet: -Z' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Applicatiori-Made-: (If yes,date---_----_-----------) Nodp---,New Construction: Yesla"'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No,sepfic iank;or cesspool permitfed if-puUiicssewer-,ia available,wifhin 200 fee+} Se ant: Distance from nearest well__ _' Distance from fours---tion ! .-.Material_ UbVVV Z)- b-s -- _______ _______ No. of compartments________ Size__;M. --Liquid depth-- --� ----------- Ca Capacity-13 - ----- Disposal eld: Distance from nearest well-.—C'----Distance from foundation----_- ..� :._.Distance to,neares# lotjing,--__-t�_____-- Number of lines______________ ____ Length of each line-_-_-_-_�0. ._. Width of trench_-. _`3b_.................... Type of filter material--- _Depth.of filter material____.__-_ 11....Total _ length_________ ___�. --------------- Seepage Pit: �isfance to nearest.welL- --_--__._. °-Distance from foundation-------------! '_.__.Distanceto nearest lot line----------------- M ❑ Nu er of"Pits----------------------Lin.ihg material---------- - -------Size: Diame --------------- Cesspool: Distance. from nearest well-----------------Distance from foundation--------------------Lining material__-.-.._----------.__-______-------. [� Size: Diameter------ -Depth -- -----------------# ---Liquid Capacity-----------------------------gals. '3 �r Privy: Distance f'r'om.nearest well --------- --------- ------_---- "Distance from ne�restruilding : --------- Distance __-Distance to nearest lot line------------ -------•--------•--------------------------------------------------- ------------------------------------------ Remodeling a,nvd/or repairing (describe):----- ------- ---.----�-f-Z ------------------------- -••---"--------------------------------------------------- - t,~ - ---------=------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------ ---------- I hereby certify that I have prepared this application and that the work will be done in accordance-with San Joaquin County ordinances, State laws, and.,rulesand.,regulations of the San Joaquin Local Health District= 11 (Signed)---- ` k ---- ----- '-_ y ------------------------------------------------------ --------------------(Owner and/or Contractor] BY•`� �� 1�' - ------ -- j - ---------------------------- --------------(Title)-- ---------------------------------- ........ ------------ P10#'lan,�showin size of lob;location offern;iri':relaf to.wells;�Iiuil"din s etc:,cen'be laced`on revetse side -" �- r-- FOR DEPARTMENT USE ONLY APPLICATION'ACCEPTED BY-- --fi! t.fA,_Q-------------------------------------------------------- ----------= DATE--- l --F----------------- REVIEWEDBY---------------------- --------------------------------- -- DATE - ---------------------------------------------- UILDING.,-PER-MITASSUED_ �'" - :9 -�,._.__:_ -DATE -------- 8 Alteration3'and/oi recammen ations:.--------______________----------------------------------- k.i,r.1 ,7 3 i f`:1V� .3 r1 1 N V 1�.W V� ---------------------------------------------------------------------------------------------•-----------•-------------------------------- --•-----------------•-•---------- - - -------•-•--- -••-------- •----------------- ----------------------- -- - ---- ------------------------------ '_ - - - ------------ ----- -- --- - -- ---------- -- - - • - ------------------------------------------------------------------ ' +� r FINAL - � '(NSP;;., - - - --- -------- --- -- ----- - Date-------------- ----' - -------------------------------- SAN --- - ---- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 380 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Califoinia Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD. � ' y