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_1........................"_..............._..-_... APPLICATION FOR SANITATION PERMIT Permit No. ------..............................----------------- (Complete in Duplicate) .............. --- This Permit Expires 1 Year from Date IssuedDate Issued —07V 0& 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. 549. 0 /V•� t--t �� JOB ADDRESS AND LOCATION........f_.i�.1..!-, ' ..............%7 �'=? .. ._. :f .f..'.. . ._._ 11=_...._ _IF.:'r.::_n.........li7....... ...... < Owners Name__ ! f x_r-. tv( i..............A.1/-471 .._. .._. "......- - �---...........-.......-...... Pone-.....------------- ..._.._..---�-... Address............. �....c............. .._..... ... ...__.{,:.�_:.r...__ .f.. ...._.. ........... .._...__. .._._... .,f,/ Contractor's -------------•--....... .......................................... .. .......................... Phone...... I Installation will serve: Residence dF Apartment House Commercial. p ❑ ❑ Trailer Motel ❑ Other ❑ Number of living units: r1 Number of baths �,! . Lot size ��f i r' Jr Numberof bedrooms ,................ Water Supply: Public system ❑ Community s stem El Private ' Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand M Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No ]� New Construction: Yes n�No ❑ FHA/VA: Yes ❑�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,:•(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well..... _ ....Distance from foundation....It'_a...... -..Material... ' No. of compartments....._r?,,:-----------Size.Y.D.C_A._.'.?... _..Liquid de th-...1 f..... . ' L%C'� p Capacity..jr............... Disposal Field; Distance from nearest well ....15.f`.'.. _Distance from foundation...-_/.(.a.........Distance to nearest lot line....`.?...._ a Number of lines.------� •--------------- -- -• 9 I!_ ..........Width of Type of filter material---fftC„ `ti _.-De th of filter material-----I`. __`..'.......Total length------- __._...,..--.•-.- �1 n t o each line_.., . 2,c Seepage Pit: . Distance to nearest 'w ..__:..........:.....Dista from foundation-------------------Distance to nearest lot line................. ^•• ❑ Number of pits------------ ------- Lining materia__ __...__.......-...Size: Diameter_---------- ,--...-_Depth........... Cesspool: Distance from nearest Il................ Dista ce tom foundation..........._...-....Lining material.-......._.....-........___._.. 1 ❑ 5' Diem a �._..._ Depth--------- -------•---.--.... -.--Liquid Capacity..... •---.--.--.... ---.gals~ Privy: Distance f om earest we ....:........ ................................Distance from nearest buildin ❑ Distance # ne rest lot tine------------- ---- - g ------------------------------------------------------------------ ----•.. .. Remodeling end/o repairing (doscribe�:_-......... ��: :_..."�f�.H.(4 ------------------- ---------------------------------------- R..l✓�.. I—_............-.................•-•-•..................--------------........................ •. ......................... ". ----------------------------------------------------------------------------------------------------..-------------------......... ...............-._................. 2. I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances; State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-. . .� .....---- ----------- --..................(Owner and/or Contractor) By:...:......................................................................... .. _......._._......--.--......_........-..-..........(Title)... . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE- - LY — - • APPLICATION ACCEPTED BY.........REVIEWED BY..................... DATE. _ ......... - ............ .. -...................._......................... - DATE..... BUILDING PERMIT ISSUED---------------------------------------------------------------- ------------------ - ------- DATE......... Alterations and/or recommendations:........ ...... ..........................................._.............................-................................. ....... r —z a �79N K_- �1~!- rA�`jZt-. NPY...ce�fVr T =. _1--- t='i-_...��rvc�� t- 4_:=. --->R. . .. r:r..r:.n ,:. �N � .._..- _. <,!— T :.._./�► r_C.,r Ta. .. -- --- --- FINAL INSPECTIQrI BY:.. 'Jll�.. ..._.. .... ..... Dat©.. . ..: .-.L.. ?.._..(�'. ........ .. .. .. .. ........................ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hasollon Ave. 300 West Oak Slreal 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi, California Manteca, California Tracy, California CC 9 HCVISCG 0-S9 31`4 3-'63 F.P.Cp,