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FOR OFFICE USE: -- M. --------------------------------------------- APPLICATION-FOR SANITATION PERMIT Permit No. ....................... . ---------............ (Complete in Duplicate) .� Date Issued This Permit Expires 1 Year From Date Issued Applicafion is hereby made to the San Joaquin Local Health District for a permit to construgLand i�1y�II the work here described. This application is made in compliance with County Ordinance No... 549. (e{(a A of/,/� (�J�L�r v rPpf)a G JOB ADDRESS AND LO ATION.t .--------8t bO-x...Q`QU.. '�l�y� /11J11GI.U( ..... Ql._.�tF�ilfh a L 'i Owner's Name------.R,-- ... .-/..-1e- .. Phone Address. [�- �_"- I --.-tee ...........902,n --_-----_.-----.._...............----- -:: - -- (� .; I Contractor's Name. -=---....-qi . .. . 9'.1!I/l _V1............. ............................................... Phone......- Installation will serve: ilkesidence ❑ Apartment House ❑ Comm r Lal [Trailer Court ❑ Mota.~['] Other ❑ Number of living units: ........ Number of bedrooms ........ Number of baths ....._- Lot size --r....../. Water Supply: Public system [I Community system [I Private Depth to Water Table off. ft. �,� Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam [3 Clay Loam ❑ Clay [I Adobe Lti' Hardpan ❑ Previous Application Made: (If yes,date....................I No ((I2'00"New Construction: Yes ❑ No [] FHA/VA: Yes ❑ Now TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicAl fsgwer is available within 200 felt.) e ' Se tic k: Dis lance from nearest w 1.. 0 ste d m Yf u tion�0. y) C P ata, ,. y f X41Iq....M +aria - (d .......... So No. of compartments_. _�`..--.--- Size-� ....... --9--_Liquid d pth I Capacil. Disposal field: 'l Distance:from Aarest"wiell__I. .PAIOistance from foundation-1Q.AMy%.Di�nce to nearest lot Nuttber�of lines-.. __l_ .'.n-_:-.r ._ Length of each line..____ .QP�.r_t-�---..Width of 4ench__.�---�-.___..t........ . ! Type of'filYe'r'material' �7f 'Depth of filter mater al----_-� ----------Total long+�----------------�BD-.-- ----._ Y Seepage Pit: Distance to nearest well.--_�,-----._._..-.-; istahce from foundation-------------------Distance Jnearest lot line................. ❑ Number of pits...................:.Lining material_:....................Size: Diameter.......................✓Depth._{`--::--i.` --------------- Cesspool: Distance from nearest well____-------_'- Distance?rogfoundation....................Lining . . .....: material........1!1�.----~-- 1F-1 Size: Diameter--------------------- Depth \, ................--.._..___.--Liquid Capacity:...-,t- ' .._._g---e_l.s-. 14 -Privy:' Distance from nearest well....._._..-._-.------_. ..... . *rDistance,from-nearest-building_M----.„,-.__----..- ❑ Diitance to nearest lot line._E—T -' - �- ....- '-- ------------------------- L - .... ( J,1L A p- 1 c --------------- Remodeling and/or repairing (describe):....Ll j/....54*&.?yj(--.... r ...� s _ .................................................. ___________ _____________ ___________________________________________ _ ___ ___I_________________________ _ t Y=- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules an J regulations of'theSan Joaquin Local Health District, (Signed)...- .. ate t �..-..--..-........(------------------'.. ----.(Owner and/or-Contractor) BY-------------......... :....-.......' -i .............t....................................----(rifle)- -.. ................................_ ...--- (Plot plan, showing size of lot, location of system in relation to walk, buildings, etc., can be placed on reverse side). "( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._...:_�._..._'.'_`_A .'-tif ....I-------------------: -- --- --- _ -A�- ATE--------/-C7.f: .-u.�_ REVIEWEDBY-------................................................------+-..------F.......... /---------------- DATE--• .:._.._" ...•.... •. BUILDING PERMIT ISSUED.. -...--t...-.... - .....- - DAT Alterations end/or recommendations:--'---- _--.-..---- ............... .-------_.......,... :. ...:::— �ru � ::- ::-_ . - . E _. .. . . ... _ .......................- -- ........ ............ .._..-----.........----.._... . --- - -- .. ..........----------_-...... ...... FINALINSPECTION BY:.____....................................................... Date.............:............,..-. �-orf->-Y�- e ; ,., SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1.Hazelton Ave- 300 Wert Yak street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manteca,Galifocnia Tracy,California ES 9 REVISED 9-59 3M 3 '63 r.P.CD.