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FOR SE: eo ________________-_..__.___ -----------._.._____-__- APPLICATION FOR SANITATION PERMIT Permit No. ._ fI_. ------------------------ -- ------ --------------------------------- ---- :.:_ .. (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 ins�hali th o� resin cledribed. This application is made in compliance with County Ordinance No. 549. [- ;.. JOB ADDRESS AND LOCATIO / ._ f ._.. - L Owner's Name_�Ar1e _ it,r_ -- -- -- - -- ---- Phone Address-----4Xx0._6 -----••-----------•-----------------------------------------•------ % Contractor's Name Phon . . Installation will serve: j Residence Apartment House ❑ Commercial ❑: Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms - -- Number of baths __ ._ Lot size ____ _________________ O ---- Water Supply:- Public"system ❑ Community system ❑ Private Depth to Water Table(a.-Q_ ft. Z Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dri y Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan Previous TYPE OF I plicafion Made(Iflyes,date.__.____'__`..__.___) No ❑ New Const ucti6w' Yes No E] FHA/VA: Yes 7] No El NSTALLATION,•AND1SPECfFICATIONS: be = (No sepfic tank or cesspool.perrniffed if public sewer is available within 200 feet.) • &4/_ 1 Septic Tank: Distance from nearest weli_S -----.__Distant from foundation__ _ �?__________.MateriaL -------------- .. I P I c Size �X, LiquidCapacity No.,,of com artments___ • Disposal Field: Distance from nearest wel€_4-0.........Distance from foundation_1Q Distance to nearest lot line__________ Nurrlber of lines____ - -_ __-Length-of each lin�C?:y"9f �_.--Width of trench.________ -' -'._-________\ Of _Type of4 filter material,., '�.- D� -__Depth .of,filfer material-- _�_______.___Total length______L _______/ Seepa a Pit: ! Distance to nearest well. d �: # -_._____bistanc rom�undatio�______________Distance to nearest lot line.____- f..._� Number of its___ P� �-----------Lining material- --�C- ;Size: Diamete�•3:3---r-- -----Depfh�Cesspool: Distance from nearest well_______----------Distance from foundation-__--�- :_.__ -__.Lininmaterials'.'. _"__'------- :• ❑ �- L --.w� ' w —+�v.r..-wl+...-.�.. ter..... 1 -�k.;-_ _ L .------__ Size: Diameter ----- _.Dept ------------------ - -- -----Li uid Capacity---------------------------.-gal Privy: - �Disfance from nearest well____ _____________ __ ____ ______ __Distance;from nearest building _ti.k - Distance to nearest lot line--------------------I -- ------------- ------------ - Remodeling and/or .repairing (describe)________ ________ r ' ----- -------------------- = -�-----------------� ---- --------- _.______-F__________________________________. t e t'� z _____ • _________________________________________.____._..- S I her certify that I have prepared this application and that the wont will be done in accordance with San Joaquin Counfy i ordinances, t e laws and rules and regulations of the San Joaquin Local Health District, i /� V�4-------------- (Signed) 'L t• -` / z = ----------------(Owner and/or Contractor.) By ------------- :j 1_ {Title)----- A/f--- --------- -------------------------- fi l ----- (Plot plan,showing size of.lot, location of system in relation dwells, buildings, etc., can be placed on.reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY f-------- ------- ------- ---------------------------------------------------------- DATE----771Z�_------: ^ REVIEWED BY t .,------------------------------------------------ ------ DATE BUILDING PERMIT ISSUED_ -------------- - ---------------------------------------------------- —,--- DA•TE----------- t r - Alterations and/or recommendations:- -- --------------- ----- -- ----------------------------------- ------------- ------------- ----------------- -•----------------•-----------••-----------•-------------••---------•------ -..------------• -----------------•----------- ---•----•- ------------'------------------------------------------ -------- -------------------•---------------------------- ---------- FINAL INSPECTION BY:..-l��/ c4 Date 7 � ��' ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltan Avi. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California E5 9 14EVISED 0-S9 3M 3-'63 F.p,CC. T '7