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-rrict.est VO F ----. APPL,ICAT€ON FOR SANITATION PERMIT Permit No ....1.. _., - 7--------- -t_ %L- - -- (Complete in Duplicate] ----------------- -- ------------- ------- Date Issued a - This Permit Expires 1 Year From 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 application is made incompliance with County Ordinance No. 549. JOB ADDRESS AND DATION..____ _ _ .__1 ;--_� f_,�,("p.✓ / cod ---------------------------------------- Owner's Name------- -----. - ;� - -- ------- --------=-------------- ---- Phone-----•---------•---- ---------------- Address----_-------------_- --------- --- ------------ -------------------------------------------------------------------------------- Contractor's ---_---------•--- _ - Contractor's Name-------------�----- •-- ------ Phone r Installs+ion will.serve: rResidence Apartment House Commercial ---•'•-'-----"" Phone__________ _______________________ Trailer,Court E] Motel ther ❑ • ll p ❑ vv Number of living unit's: __!____ Number of bedrooms ___ Number of bathsQ------- .Lot size .____ o d__-. Water Supply: Public syst pm Community system E] Private ❑ Depth to Water Tabl,6:-7ft. Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sand in ❑ Clay Laam [❑ Clay ❑ Adobe ardpan ❑ • s - Previous Application Made: (If yes,date--------------------) :No New Construction: Yes ❑ No IA/VA: Yes 0 No [�f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tit Tank Distance f l m nearest well-----------------Distance from foundatio_ri-------- Material- ____________________________------ _____.__. 0 of compartments----------------- 1 :' - . . .: 1 � / ----Size- -----------------;F--.- _L�quiciyd�th Capacity--•---------=---------- Disposal Field: Distant from Weare t well--.._Distance from foundation___ _.�f_.__..____Distance to nearest ]of line_.+___.____ umber}of lines___." __-_-.- _ Length of each`1,ne_ __ ` _ _With of french.., -- 5" ----- _- "cam` ------ N Q n/ Type oflfilter material___ _1�._ _a"_ l�' / I / _ 7 Depth of filter material_/- .-- ----�--------Total length-- "-- --------------- j -----__ N ID Seepag Distance'I to nearest well________________ _____ is ante from foundaton "- Distonce t ynearest lot lin -- Number of pits---.__�_____________Lining_material__Yd4_,�_.Si 1 *_Diam�� .- Cesspool: � Distance from nearest well_--__________.._Distance from foundation---._..__,___:___- Lining material________________-------------------- Size: ❑ Diameter------ -------------------------------Depth--------- ----------------------- = ------.-Liquid ;CapacrtY----------------�-"------gals. Priv „e _ -------------- --- buildin � ❑- Distance to nearest lot line--..__-______._ �--- ,— I 9_ i --------------- — Privy., Distance from-nearest:well_________________ _____ _ --� � �-� ___ Remodeling and/or repairir g (describe): __ ._._ . r f/ �"`77 - g f 1 ----- l -- ------ --- - f --------------- -------- _________ _----____---------___ -i-s - k -------------------'" 3 I -- = -- �""`------�---I-------------------- 1 I,hereby certify..#h I have pr - red is application and that +he work will: be done in accord ante/with?San Joaquin Count /— ordinance;,gate la a' rrules d.y r ions of the San Joaquin Local Health District. �y / .. a t ...(Signed) ------- == _,-_� - - -�" -�-- --- -- -- - - _.._______"__ :a_(Owner and/or Contractor) By: �' (Title) � { -- --- - ----- (Plo+ pian, showing size of 1 ion of system in relation to we s, buildings, a+c., can be plaoed'an reverse s� e. , ; - - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y____.- / _ '-- ------�-t---`-` -----------•------------------- - DATE-------- --------- REVIEWED BY S -.,DATE---------------- ------------------------------ BUILDING PER/1T lSSIJEQ' `/ Alterations and o_recommendations:--- __� _1`�� —r r_" ; ;'DATE------_•-----------------------,------------- .. . I ---- ----- • /P1.1C'Jyt/ ` '� � ' ��C ; _ -- - — --- ---•- ------- ' _. i , --------- ------ -� t7- --------------,-- ------- ---------- "7a _ :7_cf � ------------ --- FINAL INSPECTIONBY: - ------------- Date-------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. .I 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,Callfarnia I� Lodi,California Manteca,California. Tracy,California I ES 9 REVISED B-59 3M