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FOR OFFICE USE:,,, - 1 ___________ _________________________________________ ,M1 _.-_-._.. APPLICATION FOR_SANITATION PERMIT Permit No. . -----_..... ---------- ------------------------------- -- (CSmplefe•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 application is made in compliance with County Ordinance No. 549. �. 5' i i I JOB ADDRESS AND.LOTION- RD-,-------------- ------- Owner's Name---•------- - .._ -(- ......- � � � �� Phone. - '11�A_nl----------- -- ------ -- -;-----;--------- ----------- -- Address---------------------- Z 1 --------S----- - _ _R_1 i{-� !AK-1> Contractor's `K- Contractor's Name-----i�NxtfQN[y... -= ��® ------------------------i?_T_[_O.D-ES"f Installation will serve- Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --4---- Number of bedrooms__ Number of baths Lot size _______________--_-__-- Water Supply: Public system ❑ €ommunity system El epth to Water Table 1_9 - ft Character of soil to a,depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam 0 Clay ❑ Adobe ❑ Hardpan ❑_ „rPceyious.AppEication:Made: (If-yes;date______.____-::�" ) No" New:-Ccnsfr-ur-t;on:Y-es No.[:I—.FHA/VA:-Yes- No-E- [:I OF INSTALLATION AND_SPECIFICATIONS- [Na septic tank;or cesspool permiffed if pubiic sewer is available within 200 feet.) - Se tic T k: Distance from nearest well.... _f�..__Distanc from foun;k.&_-.-_16_.-.-_--- Leri L___C'��YOIf�JE_T P No, of com artrrients_ ._-. ._ _. Size.....xia ks-_Li Liquid de th_--- / .-Ca acit /9-Qp P q P. P Y Disposal Field: Distance from nearest w�s_�..../Len Length of each line__ -____ -r.t 77 D tance to nearest lot line__,S`` Distance from foundation___ _ YP ri.._..� -..c �� i_ P �I _. .0��_ Total len�'th�_-_l -� �� r Num er--of-lines___- Width of.trench?� --------------- T e of filter matena_- . . _.C De th of filter material...... .__ g _�;7 -t�4:___________________-_______ \! „ r Seepage Pit: Distance to nearest well...................1__Distance fromfoundation-_--__--_._-_---- Distance to nearest lot line__--_._-_------ ,_-_-._ -.Linin + { Number of pits,'€' � Lining 1,ze:.,Diamete_L Depth p Size: Diameter= - ---------------�e Distance from foundatidn:_:.._--=----,_ .Jl i ing mater al----------------------.--------------. Cesspool: Distance from-nearest wail _____________�_Dis .............. � -_ ❑ ii pfh--------- ----- -- - . ------------ -------Liquid Capacity city--------------------------gals. Distance from Privy: Distance t ea�a+es<t well----------------)-- --------.--.-._....._---__-Distance from nearest building---------------------------------------_. ii ❑ s: --------- lo+ line .------- - - .- __ -- __ - Remodeling and/or repairing (describe _ - = ------------------------•--------------------- -- ------------ - •- •- ••------------------ --� --- -. .. ' D ------------ --------------------------------- --__--_.,__._. - MK - ---------------------------- ------------------ ordinance --Sf--------------------------------------=------------ ---------------------------------: -------------------------- ------------------------------------- ---- ------------------------ I herebyCertify that I have prepared-t is application and thaf_fhe�worlr w;11-4v-done-in-accordance-with San Joaquin County s, ate laws, and rules and regulations of fhe San Joaquln`Local Health District. 6 _ (Signed} - �` ---(,Owner.:and/or Gonacfor�" ":; m 8 ------------ --- --------Title . -- -•��E-��'....._.. . _ ---�' (Plot plan, shawi g size of lot, location- ts' em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY --- Y � 1- `�---- -- --------- ----- ----------------------------------- DATE---------= APPLICATION ACCEPTED B'� -_ .- . EWED BY BUILDINGIIPERMIT ISSUED--..-----..- ... --------------------- ---------- -- ------------------------------------- DATE - -- ---------- ------------------ ----- ----- -- -------- -------------- ------ DANE------------------ Alterations --- Alterations and/or recommendations:. hr4T7_�_ _ Cf.•1A.^CC- E�---eAl-- - - ----- -- i ------------------------------------ --------------------- # � - . L` - I ii _ " ty ---------- •---------------------- ----------- -1 ---------------------- ----- - ------------- -------------------------...- -- ------ -- - I _ t FINAL INSPEC - ---- Date----- + ; - ;t SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Massillon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street f 4 Stockton,California Lodi. California Mantecar California Tracy,California E.H.9 2M 1-67,, Vanquard Press