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rUIK UrrlLt Wit: • --� APPLICATION FOR SANITATION PERMIT Permit No. _....,._........... (Complete in Duplicate) 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 and install the work herein described. This application is made in compliancewithCounty Ordinance No. 549 JOB ADDRESS AND LOCATION l0X:� 2E t � d...- mss --- a s--. I-. ..... Owner's Name _ ' -: $ .? .r. .z3. +.- .................................................. - - -- - .................... Phone. ----------------- Address...--_ .-------Address----' ----- ......._.------- -----.................._.............-......•--------'-' -----...- -........ :_, _.-;-----:-- Contractor's Name--- .......------------ i#st: 4 :: ,.,_.._ . ................................ ..........__.............. Phone.`F!c,:�__�i�. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -3-_. Number of bedrooms . ... Number of baths .3-.. Lot size _-_ !:.:1<'.".•:'•'=-`.3i.+.`.`'.-._......-._--.-.- Water Supply: Public system ❑ Community system ❑ Private r'ta, Depth to Water Table ?.- 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 ❑ New Construction: Yes ❑ No'0 FHA/VA: Yes ❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �Ie Tank: Distance from nearest well-_____.-.Distance from foundation...---------------.Material--------- ................ _q` No. of compartments--------------------------Size-..............................Liquid depth-------- ____.-._....Capacity....................... e Nitiq geld: Distance from nearest well..y ... _Distance from foundation...3.4--------Distance to nearest lot line...Z;---U_._. Ur Number of lines.........1........-._.-.....__Length of each line_ze.._O...._--------....Width of trench......._-7---__............ Type of filter material. .r.ff)'fK.�'',.__.Depth of filter material__.1.c - --.._...Total length_.-I--F'._�__._.._�.Q,Q_----- f e e-Pit: Distance to nearest well...-.................Distance from foundation--------------------Distance to nearest lot line................. `:- Number of pits------................Lining material-----------------------Size: Diameter....__...............-Depth................................ Cesspoo Distance from nearest wall .._............Distance from foundation-..................Lining material.............................._....� ❑ Size: Diameter..........---.-.._-------- `---------------------_ _ - - _- ------Depth---- - ------------------ .Liquid Capacity. '-- -....... ........gals.O 11 Privy: Distance from nearest well-..------------..................................Distance from nearest building--------- -------........._.-----.... ❑ Distance to nearest lot line.......... ........................... Remodeling and/or repairing (describe):. ..... ......... ---------------_-----............. .........._...--------------------------------------------......................... ---.-----................-----. -------...-------------------------------------------------------........- ......--.---.---...................----............................------- ------------------------------- .------------------------------------------------------- .------------------ ---------------.....-------...-------------------------------------- -------- I hereby 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. (Signed). __ -_C"} -- - . Owner and/or Contractor) B G(f=.''. j . ate. (Ti ) y:._.. .. - - ... tle ------ .. (Plot plan, showing size of lot, location of system in relation to wells, bu rung$, efc., can be placed on reverse side).. FOR DEPARTMENT USE ONLY L z.' --- --- DATE._- / t -- y ............... APPLICATION ACCEPTED BY__...-�f..__�. ......_...._-_ _-..-------.._. REVIEWEDBY-----------------------------------_.................,_. ..................------------- . DATE ........ ------............................... BUILDINGPERMIT ISSUED----------------------------------L..---..............---................................... DATE--------------------------------------------------__ Alterationsand/or recommendations:--' ------------4.... ...--------- -------.---------------------------------------------------------------------•----`-----`-----------...._------- ..........................................--....................•--------I'-............................................-....................................................._...................................... __-_...----'--._.....-------------...._....---------- ---------------------------__..................._.....--------._---.....--'--'------------................"-'--------------'--'- ...---.._.---------------.__.....------- .....-_........-------.._.._...-.......................................................... -----.--............._.._.-------"-------'-......-----'...._..... ........-'------.__-__.....................................................................................___--------------------------------------------............--------............................... FINAL INSPECTION BY:..---_ ` -,.....--PJOAQUIN .. \_....... Date.--------/fG.._-�-.�-C/..-....-..------_............. S LOCAL HEALTH DISTRICT 1601 E.tlaaellon Ave. 300/est Oak Sfreet 174 Sycamore Street 205 West 9th Street Stockton,California 6,11,California Manteca,California Tracy,California CS 9 REVISED 6-59 3M 3-'63 F.P.Ccl.