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FOR OFFICE USE: _.________._ APPLICATION FOR SANITATION PERMIT Permit No. ._ 6. �P h ------------------------------------------ (Complete in Duplicate) v S c1 JE rP_D --------- ---C• --�" C9S�._ - --.. -_. This Permit Expires 1 Year From Date IssueDate Issued Issued S-- «p Application is hereby made to the San Joaquin Local Health District for a permit to construct an install the work herein described. This application is made in compli nce with County Ordinance No. 549. IY1l��II7�CA , E S1 DF JOB ADDRESS AND LOCATIONA�-T-ONF �� '� ^�� Owner's Name-----------6�--6aDEw--------- C`t�.�1� E_,�j_ Address-.--' Lp11 PA-K0T1_4 f v( j---�OD ... �-- R-T7C----1-7 i a7......1.+MAN_'�'>�.��A.... Contractor's Name__M} fA0&A_L.D...... l + - S V.I.C- --------------------------------------- ---•---- Phone----------------------------------- f Installation will serve: Residence'lleApartment House E]/ Commercial ❑ Trailer-Court.1—Motel ❑] Other ❑ Number of living units: . ._ Number of bedrooms 3. Number of baths r� Lot size j---...___.. r Water Supply: Public system ❑ Community system I-] Private ®/Depth to Water Table Y2 ft. III P4 Character of soil to a depth of 3 feet: Send VGrevel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---- .-- �) No Zje- New Construction: YesX?-No E] FHA/VA: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool itted tif,public sewerais available within 200 feet.),� p No. n compartments _---.Size_'_ __--fr tion--,�0_�.......Mater'al-_-"QN.__<'AL=TT=' ....l.-F• Septic T Distance,from nearest weli....S._ _____ ( p wry♦t�� _Liquid depth---��Z..........Capacity.ftil --_-- Disfiance- ram oun a Disposal Field: Distance from nearest well---.t.Q...._D+stance from founds JA p � t' n -------Distance to nearest lot !n�e..,S.......... Number of lines__. --A_ V!_;K ------ - ' s► ____Length of each Irne_.- r,lWidth of trench....__.._r-------------- -- Type of filter material-_. .-.-.Depth of filter material--_.. ......Total length._______1��________________________ Seepage Pit: Distance to nearest well._............. .....Distance.from foundation.__....:.._ .......Distance to nearest lot line................. ❑ Number of pits......................Lining material--------- ----.------Size: Diameter.---------------------.Depth-------------------------------- Cesspool: Distance from nearest well-------.__-----_Distance from foundation_--._ ........Lining material-._..--________________________--- ❑ Size: Diameter------------------------ ------------Depth------ -----w`3---_c._. 5 ... ------Liquid Capacity------------------------..-.gals. Privy: Distance from nearest well-----------------_-__.....---._--.___-_-____-Di'stanc`e from nearest building-------------..--_-_.__-__.___.--_.._.--. ❑ Distance to nearest lot line..................... . Remodeling and/or repairing'(describe):_".°SE'?"Tt-c'7t9R'.K 17)-l.-$,(A-L.��'P=` SfkQm---- ------ -------- ............ � A -- ,TocERcH + .. .r.15Z-1�- 3------ vD3 - -.. _-. " ----------------------------------------------------------------------------------------------------------- I hereby certify that I-have prepared this application and the the work will be in accordance with San Joaquin County ordinances, State I w a rule and regulations of the San Joaque din Local Health,District. (Signed)----- v y ---�- ' ........................(Owner and/or Contractor) By-----------------------------------------------.-.---------------------------------•----------------------------------- (Title).......... ---------- ----------------. _... . . - ---- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc t can be placed on reverse side). i FOR DEPARTMENT USE ONLY N APPLICATION ACCEPTED BY...,��+..R __.•__.-_____________________ REVIEWED BY--- - ---------------------------------------------------------------•-------•--•-•--------.--- -- DATE.!!-------------------------------------------------------- -•-•-----------••-•----- - BUILDING.PERMIT..ISSUED.........................=------.......---........------------._x...... ------------ •='=- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------..-------------------.-------.-•-------------------------- [ �+ 14n ... . %_jv 41kJn -------------------- -------------------------------------------- --------------------------------- -•-•-•--................................. ..................................................... -•••••-•-••--..........-------...... -------------_ FINAL INSPE � Date------------- .- u SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 31A 3-'63 F.P.CD.