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NJK Uli-HU USE: = t, r -------------------- ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. - x --- (Complete in'Duplicate) - his Permit Ex fires 1 Year From Date Issued Date issued --- -�°/_• ___ Application is hereby made to the San Joa gu'm. Lro-calie'affhsDis`tnct'1for`a permit to construct and install the work h�r�r described. 1 This application is made in fiance with County-Ordinance No 549 � . f/J 0-r 4. .4 ,� JOB ADDRESS AND O Tl0�_-.. -- ��eul Owners Name-------_--•- Address ------. . ;fvl1 'C9 T [] -de Pho Contractor's Name ., 't 4. 1, 't r1 t 11-4j. '€'k------------------- VN f ............. .......... ----------, - one.--= = Installation will serve: Residence Y `" ` y,. }' v r ❑ partment House ❑ Commercial ❑ Trailer Motel Other . Number of living uni's Number o'f.bedrooms _- -__ . Number of baths -1..--- Lot size".-v,- - ❑ f �,;�, Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ft. 1 Character of soil to a depth of 3 feet: Sand [ravel ❑ Sand Loam ❑ Clay ❑ ,Clte 'Clay El Adobe.❑ Hardpan ❑ Loam Previous Application Made: (If yes ,...__-..---._:_.._] No New Construction: Yes• Vo ❑ FHA/VA: Yes ❑ No 1�;..�T_YP.E_;7OE._INSTALLATION..AND SPECIFICATIONS: (No septic tank or cesspool perrnifted if public sewer is available within 200 feet.) Sept'c nk- Distance from nearest well.._5-0-----Dista f m foundation..__1_.49.........Mat iia#._._.1. A-b No. of compartments------ c - I Size.._ -., 4�- 'dep�h.. Capacit ©� _ Y r Disposai Field: Distance from nearest eii. 0------,Distance from hdation___.-_-/Q-.-_.-:-Distance to nearest lot lin , Number of lines- -------- ---------------------Length of each line_------ Q - line of filter .maferial___.RQ[K Width of trench _. -__ - ' „.r Depth of filter maerrai.-_....f - ---_-Total length.- .. _ _ ^' Seepage Pit: Distance to nearest well ,.. � `;'. l' ------- ---•---- �, -- .._ ...- _ .Distance from foundation.....:.....:.... .. Distance t ,nearest lot line----------------- A ❑ Number. of pits . _--_ ---Lining maferial_... ..------�5rze: Diameter-._.-'- e to Cesspool: Distance from nearest est well.._---- _._ _.Distance from 'foundation- ._..---.- �. p Y- - 1 ..Lining material_.. -. ---- ❑ Size: Diameter_P¢ = Depth _ -.�+....• ,� DJ , iquicf CpacEtY --------- -- -- .-gals. } Privy: Distance from nee est well ._. ..._. �__:--_-.=Distance frorn,.nearet 6��uil g 3 r ❑ Distance to.nearest:lot line-- --------------------------� ------- �. ------- -------- --- Remodeling and/or repairing (desc�be}= Q --- �- = ...[.f' _ r 1 .� dim -: -----:--------------------•-----------AIPD ----- 0----------------- -- --- r/- ,.VA A._71Ql1L-- i 1- -1 __.: .lTr" --- ----------------------- - 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 rules and regulations of the San Joaquin Local Wealth District. (Signed)----- ..".®` --------------- ----- ----------------------------- -----(Owner and/or Contractor) FBY:-------•---_-•----- ---- ----(Title)- — ------------ .....- � - ------ (Plot plan, showing size of lot,.location of system in relation fo•wells, buildings, etc., can be placed on reverse side). E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-----;' I ' _ y DATE--------- REVIEWED BY.. -. -- ----------------------------------------------------------- Y ,.,,..,., _ r _ - DATE NG FERMJT�„ISSUED 0/1_ }f ------- BUILD] Alterations and/or recommendatlons:_.I - .S? A CT. i 11/r 7C� -.............._..-----_..._..-.....-.._�.. .. ................ . /wy �D ------------ -------- ----------------- ----------------- ---------- - ----------------------------- - -- ----------- -------------------- FINAL INSPECTION BY -. -- -- - ----- Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT; 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California f Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 N.M. 3-'63 F.F.00.