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t*UKvriI USE: ---------------------i I � -17-7:------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) This Permit Expires I 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. 0 nonce This application is made in compliance with Co my 0 di N 549 0_�(V�� " 7) JOB ADDRESS AN 'LOCATION.- --- -------- - ------ ---------------------------------------- ------- ------------------------- - --- ----------- - ------ Owner's Name-- ZiZ44 Address-----Wb�.. on --------------------------------------- ------------ ----------------------- -------- -------•-----•----- Contractor's Name---- -- -- -------- ------ ----- -------------K-------------------------------------------------------------------- 774.8-4.1 Installation will serve: (Residence t- Apartment House 0 El 05mrnercial-,E] Trailer Court E] Motel ❑El Other 53 living units: umber ci . a rooms -------- .661 Number of liv 3'5-e 77"f"ib MZ�----- Lot size ----- 44�- *."v --- ----- Water Supply: El Private Vg D;4P'_fh-Q7WEf_ee %bl- -------- ft. + ---- ----------------------------......... Wafer Supply. Public' f"[ c sys em 1 Community Character of soil to .1 # I of 3 feet: Sand El Gravel 0 --.# a dep' Sandy Loam!14 Clay Loam El Clay [] Adobe [] Harcl�an E] Previous Application Made-' (If yes,'d' atl--------------18�t: No New Cone 4 A - - on: Yes 0 No C] FHA/VA: Yes NoTYPE OF INSTALLATION AND SPIECIACATIONS'�, %.b 1� . - M - I�, O's, (No septic tank r-cesspool perm ifted if public sewer is ave ilable within 200 feet.) - PAe_ a n E'd 'f r rn well-4;�q-7 Distance from foundation------ jq-----material- Septic Tank- Di ------- ------ No. of compa C —------------ 9-• _.%J Liqqid,cl,�M1 ----------I----- 4' apacity-_80-a- f -*' f,�,, depot Field: Dist )41 re At well.---,L- 1 11 / "N e n,c-e nea Dist,�nxjr from foundation..-- . 0. m - .. -_-..Distance to nearest lot line-------------- Number of lines------ t-----------------------Len I g k of each line-------T, h 0+ 4 -----------)Width of trench____..gg Type of filter material--,Roatk D F filter-matFri�l---1 4 Den ol J-Total length-------- ----------- Seepage Pit: Distance to nearest well ---Distaincel'froffi foundation! ------------ Distance to nearest lot line -- -- --- - -------------- ❑ Nu.4er of pits.-_# k--------7Lining material------------- Size*Dia meter- Cesspool: Jr* Distance from nearest wO------- ------_:Distanc-e=frorn foundation-------------- Lining material--------❑ ---------- S;ze.- Diameter-!---- ----------- A14wl pth ---------------I--------- --------------t-Liq,id Capac;-- -------- ---------- ------gals� Privy: Distance from nearest well ---------------kistance from nlearesf building_------------------- ------ --------- Distance to.nearasdi,bf line-." vt_�. - A - -------------7------------------------------------ ___----------- ----------------------------------------------- Remodeling and/or repairing (desc .'15e)I -----------------------------I-------------------••----•------- -------------------------- ---------------------------------------------------------------------------------------- --------------I—-----------------------------------------4- ------------------------------ 7-------------------------------------------*-------------------------------------------:-------------------------------------- --------------------------------------------------------- ----------•--------------------------------------------------------------------------------------------- �j--------- i ------ ---- ------------------------------------ -------------------w-------------•--------------- I: ereby ---------------I:here6y certify that I have prepared this application and'fhat the work. will be done in accordance with San Joaquin County t, ordinance ate laws,;andd le d regulations- of the,San Joaquin Local Health District. Signe$d- ------- -- --------- --- --- U, By:--------------- - ------------ ---------------r-----------------------------------------i---- -----------------(Owner and/or Contractor) ----------------------------- --- --------------------------------------------------------------------------(rifle)----------------------_----------------------------------- (Plot plan, showing size-of lot, location of system in relation' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ... -- - ----------- ---------------------------------------•--------------- DATE------- REVIEWED BY---------------------- ------------- ------------------- ------ --------............ ......... - ---------------------------------------------------------------------------------- DATE..---------- BUILDING PERMIT ISSUED - ------------------- ------------------------------ ----------------- -------------_--------------.___ DATE Alterations and/or rec2mmenclafions.-4 -- ---- ----- ------- ------------ --------- -------- /A - - -- A------------------I----------------*-------------------- ------------------------------ --------4--------- -------- --011m ------------ -V ------------------------------------------**--------------*-----------*---------------------------- ---------------------------------------- ------- -----------I---------------------- -----------------------------I---------------------I---------------------------------- --- ------- ------------------------- -------------------------------------------------------------7- -------------------------------- ---------------------- ------ .......----------------------------- ------------------------------------------ ----------------------------------------------------- ------------ ----------------------_------ FINAL INSPECTION 10 Q Do ------3 ---------------------------- BY--- ---- -- - --- -- --------- te--. ----- JO 'rJOAQUIN LOCAL HEALTH DISTRICT YSAN AQUIN LOCAL 130 South American Street 300 West Oak Street 124 Sycamore Stockton,California Lodi,Californla Sycamore street 205 West 9th Street Manteca,California Tracy,California C"REV'SED 8-59 F,PXO.