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FOR OFFICE USE: �� J Permit No. -------------------- � - a� APPLICATION FOR SANITATION PERMIT l 4.. (Complete in Duplicate] " � Date'Issued �l--�l- 1 .-1 This Permit Expires 1 Year From Date Issued A lication is hereby made 'to the San Joaquin Local Healfh Distric# r a permit to construct and install the work herein described Thiis application is made in compliance -with County Ordinance No_ 549 J� -Qst_ JOB ADDRESS AND LOCATION-------�'ri�0----------S.-------- --�'�-l.Rs.L.�-E-------•------------------• ---------------••-- -------------- ---•- ----- Ph J/ ,f . Owner's Name h- - ----- `- ----- ' -------------------------------------- - ---------- _4 - - 5Gg��r -----------------------------------------------------------•- ----------------- ----- Address--------••-..----�Qt --�-�- Phone-//" --- Contractor's Name-------- _ = t M �I oel Other ❑ Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ _ i ❑ --- Number of living units: __.�... Number of bedrooms A?... Number of baths tot size ___7_�_____._.X-/.f1L2_t --.-------- L G y y Water Supply. Public,syst�� f.,, ommunit s stem I]_..�Privete ❑.Depth.to.,Water,Table,________,f#..,,,,.: I Character of sail to a depth of 3 feet: Sand ❑ Gra'vel ❑�5andy�Loam ❑ ,Clay Loam Clay ❑ Adobe, Hardpan i❑ ...,E r - Previous Application Mader (if yes date_------- --- - --1 No New Construction: Y ❑ No FHA/VA: Yes E]. No TYPE OF INSTALLAT10N01 ND SPECIFICATIONS: I ` (No septic tank or cesspool permitted if public sewer,is available within 200 feet.)....� rI� ------------------------------------------- Septic ---------.------`------------- Septic Tank: Distance from nearest well-----------------Distance from foundation__. MaterEal________- No. of lcompartments-------------------------Size------------------------------ q R -------------------------- i #ante "to nearest'lof`line--------- Li--Liquid de th--- ----- ---- - ------- El . _; Disposal Field: ------------ Distance from nearest wall- Distance from foundation--------_-----------D s ❑ NumbeM"of,.lines--------- ---------- ------------Length of each line-------------------------- ---Width of trent -----•----- --------- - 1 Type,of,filter material-------------------------Depth of filter.material__- _-.---,--------Total.,:M1length.._.,,--. -------=------- -------------- SII --- } Size Diameter-------- ��. ' .Depth-----------� �I- Seepage Pit: DiF#an ie to nearest well__�Dt'�_t- Distance from foundation___ j r � y � O Number of its--------/--,--------Lming materlal____e�G�.rSC-----5 p - - - .�_____.Distance to nearest o Ine__..- a��Q Cesspool: Distance lfrom nearest well-----------------Distance from f Sundation--------------------L'�nun id Capacity---------------------------- S; gals• ❑ ze: ;ameter---------------------------------------Depth--------- ----------------------- 0 ------ ------------- 9 { �t y;' .Distance from nearest well_____`___-__._`•_------------------ =---Distance from nearest building_________.__-;-- 6 Priv Ih ❑ Dis'tan'ce to nearest lot line__._-._ -� .I N ----------- -------------------------- �� - � s __ Remodeling and/or 'repairing (describe)---- -/��D-------�- --GIE'Ls�_,L_/l�G---=--�y--�-----� �-----�-----:r----��-----------=------• k t MI` -------- ----- --------------- -- ----#----- E } I 5 --------- t --------------------- - = ----------------------------- --------------------------------------------------- ------ ` ----------- -=- ---- -------------------------------•---�p------- ---------.-------- application ---- . hereby certify that�l have prepared this a lication 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. f e� I - f---- ---- ---�-+- ------- - ------------ ""tor) whew and/or Contra {Si 9ned By:------------- ---- ---------------------- (Tltlel t (Plot plan, showing`sixe of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ( } `-' ---�-��----- --------- -------- ----------- ---------- ------ DATE---- - ---- ----------------- 1 - -------------- APPLICATION ACCEPTED BY-------------- -- DATE---------- ---------------------- REVIEWED BY------------------ - .f y DATE.- - l ----�-----___. . BUILDING PERMIT:�155U�ED_________________-.---`--------- -'-- - _ ` -- s r ..��. Alterations and/or recommendations: �' ------------------------1 ��--------- ----- ----------------------------- = ---------------------- ° ------- --------- ---------- III --------------- --- -------- ---------- = ---- - t U ----- ------- FINAL INSPECTION BY------------------- --- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Haselton Ave. 3oo West Oak Street 124 Sycamore Street 215 West 9th Street 'll Lodi,California Manteca,California Tracy,California Stockton,Califor i is ES 9 REVISED 8-59 3M 3-j63 F.P-CD.