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FOR OFFICE USE: J, _:� --I- -------------------- ..--__--_-..----------------------------4: D.._--_--- APPLICATION FOR SANITATION PERMIT Permit No. ...6_7 ------------------------------------------ _.- --------- (Complete in Duplicate) 'Date Issued � / ---- ---------------------- This Permit Expires I Year From Date Issued work Application is hereby made to the San Joaquin Local Health District for a permit f ccirlsirud and install fh�';7 hherej described or a —q,, This application is made in compliance with County Ordinance No. 549. Arl iw)� 7/57 JOB ADDRESS AND LOCATION1---------`_-7_____ -------- --------•- -------*- -------•--•----- --*----- - ---------*------------------------- Owner's Wam._____7_8 7A6 -----------'. -------------------------------:-=7-. Phone.. --------------- Address-- Contractor's ----------- -------------------------------------------------------------------- Installation will -serve:-serve: -Regidence F [] Apartment House ❑ Commercial Ej Trailer Court El Motel El Other 7- r [�r Number of living units: --I---- Number of bedrooms Number of-baths 1-kn-lot size ----__.--11__,12,4^-&air---------------------- Water Supply: Public system_ El Community system E]� Private E^ Depth to Wafer Table CX_ ff. Character of soil to a depth of 3 feet: Sand El Grove] El Sandy Loam El Clay Loam E] Clay ❑ Adobe[ff- Hardpan E] Previous Application Made: (if yes,date________...__.._.] No [g-- New Construction: Yes Er No 0 FHA/VA: Yes E!' No El TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if-public sewer isavailable-within--200 feet.) Septic Tank: Distance from nearest well__�?----- --Distance from foundaflon__.1'L'__/---------Material-A-eaez It- - - -------------- ------------------ Z- No.. of compartmenfs-..--J------------------ dep.fh___d--------------------Capacity---3 J. Disposal Field: Disfance,from ne6r'e'Wwell------------ -- IlDisfQe from N founclatioJ!�!_`--------'-Distance to nearest lot line,S--"--------- mbe-r):of lines--- -- -------------------- u -- --- --------- ---(--------�Le�gfh of;each line-3,0_'. I/ 100- Width of french-------t! Type_of,�filter material-----R-d-L-k------Dqpjh.of ffilter material-----I- --------Total length------57-A-0------------------ i�) - f_------ Seepage Pit: Dis'anc ------ IDisfa'-nce fr'o"m foundafi- n-J-', 3 Distance to nearest well--- ...... 0 Distance to nearest lot line-_J------------- Number'.8f pits YLining m'aferia Size:Diameter----- .....Depth----_?�------------------ - Cesspool: Distance from nearest well----------------!_Qistpke from foundation__".:4.__._____--Lining - material-_____--..----.-----.__-- I., F1 Size, Diarineter---------- ------------------ ----DeIoT-------------------- Liquid Capacity-----------------------------g 11 - Privy: Disfance from nearAl-w-Relt-—----------- -�7 ------------- ----------------------------------------- ❑ Distance to nearest'lot line._..__.__-____--------------:------ -----------I----------------------- ----- --------------------------------------------------------------- Remodelingand/or repairin'9 (describe):-----------------------------------------------------------------------I---------------------------------------------------------------------------------- ---------------------------------------I------------------------------------------------------------------------ ------------------------------------------ri----------------------------------------- -------------- i ------------- ----------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ------------- i ------------------------ ----------- -------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be doneInaccordance with San oun ordinances, State laws, and rlules and regulations of the. San Joaquin Local Health District. .............. (Signed)------ ---J� 4; ----------------------------------------------------------(Owner an o 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 ONLY APPLICATION ACCEPTED BY--- ---- `- -�-��'�-•---�----- ----- ------------ ......... ------- 'DATE-- Z7�� ............... N REVIEWED BY------------- ---------------------------- --------------- ---------------- ------------DATE.------------ --------:------ ----------- _ --- BUILDING PERMIT ISSUED------------------------------ ----------- ------------------------------------------------------ DATE------ -------------------------------------------------- ----- - Alterafio.gs and/or reco'mmenidatiops:__._----- ' -- --------- ---- ------------------------------------------------------I---------------------------------------- W------- --------------------------- ------------- -------- --- ;44 - --- --- ---------- - ---------------*-------------- ---------- - I S 7 -------&1.!=A----------------------------------------------------- ----------;;11�------------------ 11 ----------------------------------------------------------------------------------- -- ----- ----------------------------:-----------_--n------------ --------------------------------------- - I il L�p _4 �_J--,:, -------- ----- ----- --------------------- ....w----------------------- ----- --------------------------------- -- -------------------------- .1%� - -------------- - ----- ------ --------------------- 17� —FI NAL-LI-N SPEC-TI(D N--BY:-.;-. --------------------- SAN JOAQUIN LOGAO'HEALTH-DISTRICT k 1601 E.Hax*lt*n Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ---Stockton,-California— -- LoclirCalifornia ^�-"—man teLco,'Cdl if6irn!a Trii�y7c-'aliFo-ini ES 9 ArVirrO 0-59 3M 3`63 F.P,013.