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FUR OFFICE USE: - -------------------------------------------------------- ------------------------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. .i ------------------------- ------------------------ --- (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. This application is made in compliance with County _Ordinance No. 549. �LQ� 2-(o S . I F�� JOB ADDRESS AND LOCATION-------.S f?! _'rv- U�U------ -------.�1-V11 ------- �a---- -------- ----- Owner's -ZSo-�3S Owner's Name-------------.�jol� 1 ___�.�-------- /��1 ©[�l '-------------------- ------------------- -------- ------------ Phone------------------------------------ Address------------; �--��-....--..J. GKS 0- Contractor's Name-----Ilf-v� 9i;Z --•---------••---------•------------------------------------------------•-------------------------------- --- Phone----------------------------------- Installation will serve: Residence 2]� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____ Number of bedrooms �_. Number of baths Lot size _------ Water Supply: Public system ElCommunity system ❑ Private [Depth to Water Table 3 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan I _Previous Application Made: (If yes,date-------- ---- ---) NoNew'Constc Pion: Yes [2--NoE] FHA/VA: Yes � No E]TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is avaVV ilable within 200 feet.) Septic Tank: Distance from nearest well C .-.-- a �OXut /� Material_-_ r1 a� No. of compartments------ SizeLiquid de th-_ A Y- O _. Disposal Field: Distance'from nearest well - ©---Distance from foundation--- --__---Distance to nearest lot ------------- Number of'•Lines--_ / - -------- --------------_-_Length of each line-----___ -- f------._.Width of trench------._ -I`----_____--- '6` Type of filter material---- _dG�a__-Depth of filter material--._._/ /...... Total length---.------------ Seepage _---�--��_-�-------------- See a e Pit: Distance to nearest well....,��Q.� Distance from foundaLlion-- p g - �'`�_�:Distane •#o�nearest'lot line_--------------- , Er Number of p�s'_.---- material-.�0G�;,---$`rze"©iaP�eter--__�'�. De th--..':-_ Cesspool: Distance f-om:.nearest well-----------------Distance from foundation-------------------.Linin g material -- --------------------------------- 00 ❑ Size: Diameter------- --- --"----`'- Depth-.^`.."------------------- - -------------Liquid Capacity-).- ---------------------gals. � t Privy: Distance from nearestwell----------------_---- . _-_--_--._- _._ ._Distance from nearest buildin I Distance to.nearest lot line------i--=--- Remodeling and/orrepairing+{describe): --------------------------- -•------------------------- ----- i 11''l . 1 I -------------- ------------ ------- ----- -------------------------------•--------------------------- ------ ---- -- ------- --------------------------------------------------------------------------------------------------------------------------------- -.---_____-_„--.--_.__-.-_-__-_.-------_-_-----___----...--3_--_5---_----.----....-- --. I hereby certify that I have prepared this application and that the work will 6e done in accordance with Sari Joaquin County e ordinances. State laws, and rules and regulations of the San Joaquin Local Health District, } -- (Signed)------------------------------•-----•-•---------------------------------- ------------------- ---------------- -------------fl_OwnePrand/or Contrac+orl .r. Sy:---------------------------------------------------------------------------------------------------------------------------------- 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 DATE--------- REVIEWED --- APPLICATION ACCEPTED $Y- ----�T-i--�R-'-�� ---------------------------------- -- - ----,�`�-��- ------------------- - ----- ---------------- — REVIEWEDBY-------------------------------- ------------ ---------------------------------------------------------------------- ------ DATE BUILDING PERMIT-ISSUED---------------=-- DA7 — T � x Alterations aril or recomri -de+ions: -_ - :--�C V _ --- -- Y_�IT -- t%1 ------/----...... �-- -T -.�-iUD ------7-11 -------------- ------------l------------ r � -- f ---------------------------------------------------------•- -------------------------------- --------------------------------------------------------.-.--------------- --------------- ------- --------------------------- -------------------------------- -------- ------------------------ . , _ - --- - - -- -------------- ------------------------- ------ ---- ---------------------- -------------------- FINAL INSPECTI ----- ---- Date - 'r� = I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 5-59 31,A 3-'63 F.P.CD. w At.