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FOR OFFICE USE: x 1 / 23 S ----- ---------------- ---------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. � 9 ----------- (Complete in Duplicate) Date Issued _ r _ pp "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 in compliance with County Ordinance No. 549. JOB ADDRESS AND /'LOCATION ---AaZ-_1/s ------ -��-�_------------------------------------ ----------------------•-- --------------------- Owner's Name.....--:!"'�/"_�" 19�r. �� t� ----''--------------- -----------------------, Phone------------------------------------------------------------- - --------------Wl-rl ... � L ��p-=-`-------- 4 =------------------------•-•---1-----------------•-----------•----•----------------------•------- Contractor's Name----------------- —------------------------------ ------ Phone---------------------------------- Installation will serve: .Residence [ 'IApartment House ❑ Commercial ❑ Trailer Court ❑' Motel ❑ Other ❑ Number of living units:.__f-- Number of bedrooms __.Number of baths __rA___- Lot size -410-49-:X_--- ________________-_-__ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _�' ft. Character of soil to a do-p+h of 3 feet: �Sand [] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay❑ 'Adobe Hardpan ❑ T Previous Application Made: (If yes,date--- ----------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ N j TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank-'or cesspool permitted if public sewer is available within 200 feet.) y Septic,Tank} Distance from nearest well-----------------Distance from foundation----._� --:__--Material---------�- ------_-------------------------- ir,xlfh4f No. of compartments.----.--- -•--'-__--Size-___�___-��3______.---Liqu:d depth------�� ------Capacity.-.�� ------ Disposal Field: Distance from nearest`well_...�--_--Distance from foundation..._/p_�___Distance to nearest lot line "_'_---_ } i Number of lines--------- --- -�_-- -Length of each line----- -e_- ---------------Width of trench. ---------------------_----- f Type of filter materialY� 1 _-Depth of filter.material---le? - --.Total length___,Pf -------------------------- Seepage =---------------------Seepage Pit: Distance to nearest"well_.___...-^---____:Distanee tlfrom foundation____XP. nearest 99-10, Number of pits-----f-.----------Lining material_./ _..Size: Diameter_.; .�_.__ . De to- " _____.Dista to � � - P - Cesspool: Distance from nearest well----_--- '----_*Distance from foundation--------------------Lining materialL.------------------ -------------- ❑ Size: Diameter - Depth id C Liquid aci P + '-=-------=----..........gals. ;! Privy: Distance-from nearest well------------------------------------- -----------Distance from nearest building.___-_._--.__--------_--_____-_.-__---_-._. ' ❑ Distance to nearest lot line-- --- ------------------------- ------------------ -------------------- r Remodelin and/or repairing __________________ T -------------------------- �f�� = --------------- ------ ------------------------------ ------•- ------------------------- - -------- ---- ---- -- - -------------- - - ----------------------------•-------------- --------------- ----------_---- -i---------- --•------------------•-•----•-------------------•--•-•----•--------------- ; - ---- ----=-•-------- -----------------------••---------------------------------------------------------------------------- = ----------- I hereby certify that I have prepared this application and that the work will be.done in accordance with San Joaquin. County ordinances, State laws, and rules and regulation of the San Joaquin Local Health District. _ (Signed) ---------------------- = (mor Contractorea---- - ) r " 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 / J APPLICATION.ACCEPTFD BY ---------------------•----------------- DATE----- REVIEWEDBY------------------------------------------------------ ------------------------------------------------------------------- DATE------------------------------------- BUILDINGPERMIT-ISSUED----•--•------- ----------------------- -- -------------- -------------- -------------------- DATE------- -----=----------------------------------------�- Alteration� and/or recommendaton -f� s:-=---- f ' .... ..�?� �'` `� �� - L c :-`'- ' ' 2 1------ ... -L�t. � if r-C.c ✓ 'z - -�'``` = -------- r `I2 r -s c-c r?- c'a L --�---- .... ---- ---------------------- ----- _ Y..e �•�e GV Cr f�' -- ---- .....____.._ ._..P___________ ___________ �.----.-.-_._-_-_---..-___--_.-._'-_--__-------_._------..._-----_--___.___..___________-__-______-..-_ ---------------- ------------- ----- -"---- - -------------------- ----------------- ---------------------------•-------------------------- ------------------------------------------ FINAL INSPECTION BY:. ` `'J,: ------ ``~ -=---------- Date- 1 ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatellon Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th street Stockton,California Lodir California Manteca,California Tracy,California ES 9 REVISED a-59 3M 3-'63 F.R00.