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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ._ 6. fP 1� ------------------------------------------------------- (Complete in Duplicate) S —Ace--ro.JE "- Date Issued -----.•_. -_-�• _-�" :----------------___.... This Permit Expires 1 Year From Date Issued 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. 11/1f}nl7ECA E siD JOB ADDRESS AND LOCATIONArON �fl �,r,/ "..,�� N o �rTR . - ----------------- Owner's Name----------- V /y.• aViz��` � � IT __�i�!E-�?.- 5 !Y_ 1 Q•S/_N. -.?iaw� Address-----?0,16------AA.KO.Tc1 AVF_ -MOD -. ....... I �T�i 1.- �3-px'j--1 ...... Contractor's Name-.MC !?A)-R_L.A_.... ?T_._0:�-=_ ._SVJ.C.a--......---•-----------------------------•---f--------- Phone................................... r Installation will serve: Residencei[j�Apartment House ❑/ Commercial ❑ Trailer`Court.[4—Motel ❑ Other ❑ Number of livingunits: ..,.. Number of bedrooms .' - _._-�__�_..._._RG :`-�..� � ��._ Number of baths - .x. lot size _�.-....___ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table �2 ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date..- No Z;,--New Construction: Yes 2?-No ❑ FHA/VA: Yes P9---no ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool itted tif,public sewer.is available within 200 feet.) Septic 7 Distance from nearest well....f7 ----Distance d rom foundation--l�.J. ------.Mat�rQ.NLr ... ..(.�F. No. of compartments....._. .-..--Size.h.4�...-_-VA .`..Liquid depth--- _-Z ...._-_-..Capacity-----��---.- Disposal Field: Distance from nearest well-_._RJ.Q...._Distance from foundat' Distance to nearest lot line..:� ------- Number of lines.._.._ -. .-._-.Length of each line... Width of trench.-- _�.-. Type of filter material... .. A-C�1___Depth of filter material..-..�-�...±11......Total length.---...-1tD........................ Seepage Pit: Distance to nearest well----------------------..................Distance.from.foundation.......,.._!...... Distance to nearest lot line................. ❑ Number of pits----------------------Lining material-------------------- --Size: Diameter.__.------.._..-__---Dept h_-_----_---_---..-- .......... Cesspool: Distance from nearest wel .................Distance from foundation----_. ........Lining material......-_....._.___.__-____.._...---. ❑ Size: Diameter--------------------------------------Depth---------I--y- t�MsA--- --...-Liquid Capacity------------_-_-------...gals. Privy: Distance from nearest well___________________________ ____________________I_Distance from nearest building----.-.-..._..------..-.__._._--_-_-..._.. ❑ Distance to nearest lot line-••--•................................................. .......k----- ---------------------------------.-.....----------------------------- 12`18-63 _ ,.�.r Remodeling and/or repairing,'(describe):.-` _C+_ ' '1�lrlri_--/I�SHl.4- �P. _ 4M.._.FAIN-QT.!i? ..-.�Q....RF!4k4RE ------ .. .................•-------------------_...--------- 1 ----------------------------------------------r-t.R.- ..............- ------ ------------------------------------•-------------------------------------------------------------------------------'--------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 I w a rule and regulations of the San Joa. in Local Health,District. Si ned v ( 9 )------ `i ' . --.• 1 �.. (Owner and/or Contractor) By:--------------------------•-...................... --------------------------------------------------------------------- -- ----------------- --------- - ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc`-t ca 'n be placed on reverse side). i FOR DEPARTMENT USE ONLY • art � APPLICATION ACCEPTED BY ' ' --------------------- DATE------- Z `� REVIEWEDBY--- ---------------------------------------------------------------------------------•---- .............................. DATE_............._...-------- BUILDING.PERMIT..ISSUED._..---_------------- r DArTE�--:=------:' - - --...__-'.'__- .-.-.-------- .:.. r -� _...,. - Alterationsand/or recommendations:----------------------------- -------------------------------------- ------------------••----•--•-•-•-----------•--..--.-.-----------------------------•----- ---------•----• .....................................................................................:----------------._.::, 1� - �ttl :�V%_jA r: Jnb -•- --- -----------------------------------------•---------------...................................... ---------------•-•----------------------------- ...... ... ........................•--•------------...................------------------ ... .._............. -------------- L\ _m*(.- . * " . - FINAL INSPE - - Date------------- �_._`._ ..' � __.--................... 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 B-59 3M 3-'63 F.P.CD.