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F R FFICE USE: =- -�If ry APPLICATION FOR SANITATION PERMIT Permit No. /77//-----.. ' -------- --------------------- (Complete in Duplicate) � - Date Issued _ --- - -- - _._- This Permit Expires 1 Year From Date Issue - Application i- 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. 549. , IDSa /V t JOB ADDRESS AND LO ATION - ��`-�--- Y ------------------------------------- .F 4aO�j----------------- Owner's Name---- i �AW-1w, ___--- --------------------•----- - - -----li/.7 Ie'_; ,��_._ i �Pfi6r�e AddressZ � ;-----•- 'Ci• . l = Contractor's Name.........--------------------------------- ---- 1 ------------------------------------------ Phone tP_wl..... -- Installation will serve: Residence C] Apartment House ElCommercials❑ Traile,� Curt ❑ Mote,1 ❑ Otheerr o size. Number of living units:_______, Number bedrooms ___",____.Number of,,bathsv�___,-_ ��--�--�---�$ Water Supply: Public system F1 Community system ElPrivate Ej�Depth to Water. Table '�� ft. r �. Character.of soil to a depth of 3 feet: Sand ❑ Gravel E-Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ O t Previous Application Made: (If yes date___________________1 No El New Construction: Yes No E] FHA/VA: Yes ❑ No El -T TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank,or cesspool pt rmit+ed if public sewer is available within 200 feet:} _ `""b,;, Septic Tank: Distance from nearest well__�4------Distance,from foundation___l_ -----___Material_ _ ------ - :Size--_� XY--- 'Liquid depth---- -- _ ----C'pacity_.AA7Q__4 19 -- No. of compartments_.- — q � Disposal Field: Distance from nearest weli..�1..d-_:-I'Distahce from foundation-- --j--Distance to nearest lot line_.S-------- ° _"_ : Len th of each line_ t2____---. -®----.Width of trench." '� ,.---- Number of lines------�------- y 9.. _Total length--------------------r9--'�------------ d Type of filter,maferial._S! ___Qepth of filter material___f�-.--- -1 Seepage Pit: Distance to nearest well/ --- Distance f om foundatian__1D�.---.Dis#ante to nearest lot line_____.__._. , a r . Number of Pits-- -- -----------Lining material-- -----"-__-- Size:'Diameter.:>33_ Depth----a-J------------------ x y t— a Cesspool: Distance from nearest well_-_______________Distance from foundation_____.____-- - - Lining,material____._.._.___.___:._____'_________: ❑ Size: Diameter--j -----------Depth-----------------'------------ -- --------------- Liquid Capacity-; gals. f Distance from nearest building t I 4:A, Privy: Distance from'riearest well------------------------------- 9 a ----- ------ �� ❑ Distance to nearest lot line------::______________________ " •� -------------------------- Remodeling and/or repairing (describe}: -------------------------------- --------------------------------------------------- = 1 ------------------------ -------- - - --- -'--------------------- -----------' ---------"----"--------------------------- "'------'""---'------'- z------------------ _---------- 1 hereby tify tha+ I have prepared this application and that the work will be done in accordance with San.Joaquin County ordinances, a laws, an rules and regulations of the San Joaquin Local Health District. . Si ned --------- --- ---------------------- Contractor) -- ------------ --------- - _._"_-Owner and/or � -- �----------- ------------------------(T tle)(Plo - t plan, showingsize of lot, location of system in rela+ion.to v/ells, buildings, efc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ---- " ---------------------------- ----------- DATE 7 5� REVIEWED BY-------------------------------------------- ---------------------------------------- ----- --- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------='------------------------- ----------:----------------------- ,;._. DATE -: .' Alterations and/or recommendations: .• ` --------------- -- ----- yi 4 — -�- ---" --------------E ---- -� -1-E' -- ---- ------------ -------- --- --------------------_---- --------------------------------------------------------- FINAL INSPECTION BY:.._____".-,�".---------- - --- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave'. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 4.� Lodi,California '� s��* Manteca,California Tracy,California Stockton,California `.,.,, a ES 9 REVISED 8-59 3M 3•'63 F.P.CD. '� a I t� �