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.,FOR OFFICE USE: ------------------- ------------------------------------ --------I----- --- ----------------------------- -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . .7: FS,. {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 described, This a i ti mad m lianrwc County Ordinance No. 549. I p/Ji a � a N l�c JOB ADDRESS AND LOCAs 7f N RN V�1 .2 Ci p �` l_A4 'rON_�-----------------------------•-------- .. Owner's Name-------F-- = - --- ----------. Phone-------•----•------------•----------- p tl � # RT. _ Address---`1--• _--f tT � ��a '� 0 ContractorsName------------0_Vll7Ll _V'---------------------------------•-------- --------------------------------------------- Phone__--•---•--------------- Installationwill serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [ -1A ,o - Number of living units: __ -__ Number of bedrooms A- Number of baths -�___ Lot size ---/9-Cj�'_ �-------------------- Water _- r ---------------- Water Supply: Public system ❑ Community system ❑ Priva#e �epth to Water Table -.I-- ft. Character'of soil to a depth of 3 feet: Sand Gravel_E] 5a' dy Loam ❑.� Clay Loam E] Clay El Adobe ❑ Hardpan C]Previous Application Made: {If yes,date..............__.:_) No. New Construction: Yes Z4---No ❑ FHA/VA: Yes ❑ No TYPE OF'(NSTALLATION AND SPECIFICATIONS: (No}septic tank or cesspool permitted if public sewer is available within 200 feet.] -_ z Septic,T,64: Distance from nearest well___ Distance from foundation � ____MateriaLe �R�T �# No. of compartments-_---- �_-_ ._.---Size__ __A_!. _x_S__Liquid depth----/rlr�� Capacity__,�4��---- p Field: Distance from nearest well__5D---.._Distance from foundation___-/0 .___..__Distance to nearest lot lme__�$_~-_-- [/� Number of lines----_------ v� Length of each line______? Disposal ;; ---.Width of trench �----- -- Type of filter material--_8Q_G�_.__Dept h of filter material...... length__________.E�O____-_______ _______ 0 Seepage a e Rit: Distance to nearest well______________________Distance from foundation--------.-----------Distance to nearest lot line----------------- 1 El Number of pits--- - Lining material----------- -----------Size: Diameter--------------- -- ----Depth----- ----- -----•---- E eCesspool: Distance from nearesw _; _______________Distance from foundatio _ _____________.Lining material-.._____..__._.__-________ _____ � I Size: Diameter______ _____ : .------------Depth----------------- uid Ca acity---------------------------gals. T Privy❑ Distance from rzeafest well-- " ell_ ---Dist Distance from nearest building___________________________ .-� _ ---- -- Distancefto nearest lot line-..._ ______- ---- -- - •--- --/------------------------------------------- Remodeling and/or repairin {descri6- .. -S (Y A__ Z.A jj f - � c�,��}��T-r_G/1E-- d - - x 5'rn rEc� --------� L3EY ! 1 C i nf� 17F,=------ .T,Rji ►— ------- JI f - ?---------------------------- - ' ` ,- --------•----------------•-----------•------•---------------'--------- --------- --- ------------- Lf� Iihereby certify that I have prepared this apoic tion and4hat the work -6e done in accordance with San 9oaqum County ordinances, e s, and � � � ulations f theeSan^Joaquin Loca-I'Healfh'Dist"riot:"""""`"' (Signed] 4' a-------------------- { •-r - � ---------------------------•---------- - ------------ ---(Owner and/or Cofntractor] By:, -------------- --- - R (Title)---------------------------------------- - - " (Plot plant3showing-sixe of lot;Iota ioreof syst77 em�in-relation to wells, buildings etc.,rcan 6e placed-on-reverse.Sid e]:- T -- �— FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .• ----------- ------------------------------------------------ DATE------ REVIEWED BY - ----- BUILDING ----- ---------------------------------------------------------------------------------• DATE----------------------------- 1PERMIT. ISSUED:------------------ - _____-= =• DATE--- ----------------------------------------- ___. .;.�.�_ . ..w -- --- - terations and/or recommendations __._.___._ '^ f I = ----- .---- �� ------------------ ---- -------------------------------------------------------- ---------------------- ------------------- -----------------jj------------------ ------------- ------------ FINAL INSPECTIO- ;• _ Date:..........a r --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 134 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 3 r1EV15 E0 a-59 3M 3-'63 F.p.0 O.