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:%/7/67...... ... ---. .... `17 APPLICATION FOR SANITATION PERMIT Permit No, .......... (Complete in Duplicate) .......... This Permit EmktLUear From Date issued tel— Issue'd Application f-Is h!reb —(31Z4—S-2. .... . Iy made to the San Joaquin Local Health District for a Permit to construct and instalItthe wor� herein described. Thisapp application is made - compliance 'fh County Ordinance No. 549. - -a- ecomp lance Wl -1_. - 4457- _-T1.bC . -a dQ 77 JOB ADDRESS AND LOCATION... I _4.. Owner's Name.......Z P.H_A., ..........4CA.11A...... ......................................... .........z.............................. Phone............ .................... Address. - 1 7o,5-_ 4....14p.e 0 ...............sx.v.�-ft.770--V.................................................... Contractor's Name...4_M.12Act13,rk7 .4-10.01 Phone..:qlk.a., Installation will serve: Residence [I Apartment House E] -Commercial El Trailer Court Ej Motel. [] Other 56 " Number of living units: Number of bedrooms __--.. Number of baths =_ Lot size ....rARq.................... Wate j r Supply; Public system [] Community system [I Private 14 Depth to Water Table ........ ff. Character of soil'to a depth of 3 feet: Sand [I Gravel E] Sandy Loam E] Clay Loam W Clay C] Adobe [I Hardpan C] Previous Application Made: (If yes,date-----------I....._) No New Construction: Yes X No L] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS; (No Septic +ank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well,/ Distance from foundation...,3-0---P7..Maferial.... No. of compartments......A...............Size... -_-,414ASAr Liquid depth--------YO-10........Capacify...0010.AfA Disposal Field: Distance from nearest well./il?.Q_AF?._.Distance from foundation.......YLAX.Distance to nearest lot line................. Number of lines_ ........Length of each line-.......IVO----rA..-.Width of trench_.,?%.3/-!!................ Type of filter Depth of filter material...1Y...........Total length.------ Seepage Pit: Distance to nearest well-4.Y04-�7rDistance P from foundation...Olfrk_Distance to nearest lot line.,............... 5( Number of pits....../............Lining ma+eriaIX___Rdf4-iC..Size: Diameter.......T.Z........Depth-----A 4 "---.......... f NI Cesspool: Distance from nearest well.................Distance from foundation............--......Lining material....... .................. ❑ Size: Diameter...... ---........ .............Dept It............................. .................'....Liquid Capacity- -------- --gals. Privy: Distance from nearest well,._...--.._..._._._._...._..................Distance from nearest building_..._... .. 4 ------------ ❑ Distance to nearest lot line: I Remodeling and/or repairing (describe):-----T. $.........t --------- ........ .. ................. ...... ..... AeWct'o--------- ........4 64.......... AW F ..�T U�I PW&A'!7...... ............................................................ ------------_.............................................__............._ ................_`----.................. ........................................................ ....................._.........................__.................................. ............ .... I lhereby 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 regulations of the San Joaquin Local Health District. I • (Signed).._.4..V7.--Af 43.Cf.,7—_.... _._.P/P&------!51Q-'-------------_------ ------...Owner and/or Contractor) :By..... .. ................... .. ............. ...................(Title)------&6-p------------------ - ------------(Plot --- plan,Ian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPRTMENT USE ONLY APPLICATION ACCEPTED BY.......... REVIEWED BY...-...................... ....*......................................._ DAT ------------------------- --------................. -------- ----------------- ...................... ...... ......... DATE-----------..................... ------------ ........................... BUILDING PERMIT ISSUED..- DTE _ltp- .- ......................... ................ Alterations andor recommendation _/ ------------------- ?Pr w ........................................................................ . . . .... .......I...................................................................... ......................... ---------------........... ............................ ........................................_........... ......... ............ ........................................... ............... ------I-------................................................................................... ....... I---------------------------------------------------------------- ----------- .............................................................................................................................................................................. .......................................... FINAL INSPECTION BY:........ -._s........ ��41.......... Date...... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.H..elf*n Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.Co.