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hUKUtklC.t_y5t! ,s --------------------------------------------------- �. _________________._.-_.___________._--._____-__________- APPLICATION FOR SANITATION PERMIT Permit No. ---- -----------------I------------------ --------------- (Complete in Duplicate) ------- This Permit Expires 1 Year From Date Issued Date Issued .__ /1_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and inshall the work herein describe . This application is made in compliance with Count Ord' ante o. 549 ni JOB ADDRESS AND LOCAT10NJti_AV—__6A_RDenL-- _ .Va-.....NO-07----- U- 4 ---I u Owner's Name_._-_.--- . '"--------- pi,-F—,T=T--1----------------------- ------------------------------ ----------- Phone------------------------------------ Address---......... ------------------------------------------------------- Phone----------------------------------- -------------------------- Contractor's Name-------o-��p ----- -rtInstallation will serve: Residence Apartme�'t House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�----- Number of bedrooms --------!Number of baths _:-�___-_ Lot size ------ ----_____.____. Water Supply: Public system ❑ Community system ❑ Privatejt�Depth to Water Table f ft. Character of soil to a depth of 3 feet: Sand ❑t Gravel ❑ Sandy Loam e Clay Loam Clay ❑ Adobe❑ Hardpan C❑ Previous Application Made: (If yes,date------------IJ__1I No tel+ f New Construction: Yes No ❑ FHA/VA: Yes e No ❑ ` TYPE,OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well---- e from foundation___f0------__Material_--- -RIEI-�--------------- r_ � r No, of compartments________ __...._ Size__ ___._ ---..X_--__--_.___Liquid depth___ 2„t,,---------Capacity___- �� Disposal Field: Distance from nearest well..z� Distance from foundat1on,_tf_ Disanc�e to nearest lot line__57~ Number of lines__ ��--___�,.�__l ___-Length bf each line__ idt'h of french_..:..... ' Type of filter material__to-G.�r,_ -____Depth of filter material____.- -----Total length---------------------- Seepage Pit: Distance to nearest wei -----------------Distance from foundation_" _____.Distant to nearest Number of pits._`____Lining materi- 47 _-Size: Dia met _ _____ __ _ _______Depth-----x_ Cesspool: Distance from nearest well--------------_-Distance from foundation._ ----------------_Lining material_______...:---------------_---_-____ ❑ Size: Diameter-------------------- '----------------De"p_fh'_7 ------------ ----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----_____________________�!_74 �_______.___._.-_Distance from nearest building____________-_____---_---.__._---.___-._. ❑ Distance to nearest lot line------------------------ -------------- -----------------------------------------------------------------------"--------------------- "4 ~ Remodeling and/or repairing {describeJ:-----__----- i ----- (�A --T - --- �f�-.-: f�)7 ,eeIFQQ �._--"a -- t — /. ------------------- -----n----------------_--- ------------- ------------------------------------------------------------------ ---- --T 2 - AIt- z DGK -----�-IFNC '� I} D!TioNA-L. /1` � �'��{.O• /r - -Qn46-t� f Rid ._ e4� '� RAS orK - `�' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County W ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 0 (Signed}.. t` _ . .. �.�. (Owner and/or Contractors V� -� - ---------- ------------------------------------------ �, y . ; '(rte)' (Plot plan, shov&g size of lot, location of sy in relation to'wefls, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE)ONLY APPLICATION ACCEPTED BY..-Tr R_` ----------------------------------------------------------------------- DATE------- REVIEWED BY ----------------------- DATE-------------------•-------= 3 BUILDING PERMIT ISSUED----•---------------------------------+----------------------------------------I---------------------- DATE. Alterati ns and/or re ommendations:zy - -- -.---- •_--•,`-------------------------------------------------------------------------- - Rrf� R �WL.a p-- ----QEttSEr Unf-PRIRiIE3 DRHI _ [L191�_11R +9 -7. - -_. R 'OU_T`� Q► s 'Sf t`''1 h "�` 5To-------��_-------- rte- 13- C --- o 1�F---- aa�-----Ar_rR�H_ED- --------- T-[3.49-- FINAL INSPECTN BY- --- Q --- ----- -- --- Date--- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stackton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 3m 3-'63 F.p,CD.