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E FOR OFFICE USE: ' -Y ---------------- - APPLICATION FOR SANITATION PERMIT Permit No. .... ..... ------------------------- =:-- (Complete in Duplicate) Date Issued'---��_v f--- 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 here's described. This application is made in compliance with County Ordinance No. 549, _ JOB ADDRESS xI- j kES5 AND LOCATION----------=��.�_E�----- -- -�- '-��.,t*x-z�.`G'F-�-=-------� --'--------------- -- ----------•--- --------- „� Phone--- "----------------------------- Owner's Name--- �`�'�---=-- --G ' s1�. _ ----�� - --------------- ---; ti_.- � f - � Address 4 ------- �-'-{-'---------- ----- - _ -----•-•----------------•---._.. __ -.�-=--r---------------------- --------- Contractors Name----------- p ❑ ❑ Installation will serve: Residence Apartment House Commercial "Trailer Court ❑ Motel ❑ Other ❑ Number of livingtunifs: __f___ Number of bedrooms Zr Number of baths Lot size ----- s '-�-- ---- Water Supply: Public system ❑ Community system ❑ PrivateX"Depthto-Water Table _6ftp Adobe Hardpan Character of soil to a depth'�of•3 feet:�Sand El. Gravel [-] Sandy Loam ❑Ir —Clay.Loam ❑ Clay E] J2 , f FNA/VA: Yes No !I Previous Application Made: '(if yes,date_..---_____________) No �] New Construction: -Yes ❑ No ❑ i k TYPE OF INSTALLATION AND SPECIFICATIONS: :- i (No sepfi�c#tank or cesspool permitted',if public-sewer is available within 200 feet.) u ❑ . t foundation Tank: Distance' from nearest well_________________Distance from _-v_----Material__g_ __..._______._____..__--.____________.______ Nof compartments--------------------------size__.----------------- ----------Liquid depth------------------ CapacitY--••------------------ . .� :!I .ti. r Disposal Fi d: Distance from nearest we'il__l.[ _�._.Distance from foundation_._- _� ____..Distance to nearest lot Gne.__ '' Number,of lines----------�------------------ --Length of each;line___.------�__---------.Width of trenc1;8h.___________,__, Type offilter mateial �___ �Depth.of,filter. material___._ r - ---_-Total length____________________________ + • r +S r Seepage+Pit: �• Distance to nearest well----/ ........Distance from fou dation_-�-n__._.___.Distance to nearest lot l'me__.____-.- t� yam, ] � .Number of pits.-----$/-----------Lining materiaFX-------------- -=Sizer°D'ssanieter &�'�__ -----=-Depth-------------- ------- �I Cesspool: - Distance from nearest well---------------__Distance from foundation ______ -- --Lining material_ .-_ ❑; Size: Diameter--------------------------------------Depth.--------------- ------------------ -----------_:_'Liquid Capacity --------- ::--:---9 als. # - Distance fram�nearest,buildin Priv Distance from,.nearest�well------------------------ -- --------- - ; g F. y s - ------ to nearest lot line-- ----------------------------------------------------------•--------'- - ------------- ----------------------------- ❑ Distance -"-- -- - I i<x I r - ->2�w i7 s;_ - __�_1t is —�S -------------------------- Remodeling i and'/ory.repalnng-(descnbe]:___--. "--; �'�'-�=��-"�-`'z- h� �• Is k ----------------------------------------------------j'--"F-- ----------------•----------------------------------------- ------------' ---------------- -1. s '--------'------------------`-------------------------`-----------------------•------"---•`-,--i_•-----11-'-- -----------____.----- hereb certif that I�'have ---re ared this application and that the work will be done --------------------------------------------------- _ accordance •_ ______________ _Joaquin n --------------------------- ------------=- ------------ ---. -- YT y p P pp in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -. -- °� Owner and/or Contract&' ------ ' (Signed}.:------�-- ��c.`.--`--�'----�---------- ---------•-------•-------�-------------------- { � , Title_-_______; ( plan,Ian, shog win size.of lot, location of system.in relation t�buildings, etc.,,..can be placed on reverse side). t # l FOR DEPARTMENT USE ONLY ) Q�'-Z '---------------------- ---- DATE_.--- �' APPLICATION ACCEPTED BY--------------L.. ___ ----__----- ---------_ --- i € REVIEWEDBY =----------------------- ------------------- --------- ---------------- '------ DATE BUILDING PERMIT ISSUED `J � 3 -`-�- ,----' p - DATE��`= `- _ I �7 t---. Alterations an recommendations________ __ ________ _. _ _�-_.- -- ---v-- - -- � f h -----------_ ---- ------------------- ---- -------------------- -- ------ --------------- �tio;s ____ _.___ per-•- ' _____________ _ __________________________________•___—.-______________--_.{ �� -- -- -------- ! tIf ----- ----------------------------------------------------------------- ----------------------------------------------- --- �-FINAL INSPECTIO -71 e5l N BY______________ ________________ _ Date --- - I S N JOAQUIN LOCAL HEALTH DISTRICT I , 1641 E.Hosalton Ava. 300 West Oak Street 124 Sycamore Street 205 West 91h Street 5lockton,Californiali Lodi,California Manteca,California Tracy,California I ES 9 REVISED B-59 3M 3-'63 r-P.OD. i