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1`0h USE.. --------------------- Permit No.------------------------ ---------------------------------- R_ fir APPLICATION' FOR SANITATION PEM - ----------------------------------------- --------------- J (Complete iW Dupaofe), Date Issued _V This Permit Expires 1 Year proi�i 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 compliance'�with County Ordinance No. 549. JOB ADDRESS AND LOC TION-----------------------70 ------------------------------—----------------------------------------------------------------------------------------------------- Owner's Name--------- 7 ---------------------------------------------- ------------------ Address-------------------- ------ . ......... ---------------- -------------------------------------------------------------------------------------------------------------------------- t f%/ i - I`sContractor's Name2------- - - ---------------------------------------------------- ----------------------------------------- Phone..------_----------_-_------- Installation will serve' : Residence artment House.E] Mm r i I -:]-Motel [j Other E] a Tia Court,[ ia J� Ilia 'd ro o m 3--- Numb s Number of living units: _-±__ Numberof bedrooms eN�Umiert bath Lot S" ------------------------ f Water Supply-Pulic,.system "Ell Community system E] Privatel[eDepth tc; Wafer Table -------- ft. * . J L - Character of soil to a depth of 3�fIii6t: Sand 0 Gravel E] Saoy,LOam 0 f6lay Loam E] Clay F] Adobe ®/Hardpan [I Previous ApplicationIf ----- No 01" Made: ( yes,date--------------- New Construction: Yes 9?"Nq El FHA/VA: Yes P TYPE OF/INSTALLATION AND SPECIFICATIONS: .(No Septic tank or cesspiol permitted if public 0 bI -sewer is ava ble,;Y�itkin. fed ---Distance fr m fagadation-------------- M;:;;f!�rie ----- fl, Septic Tank- Distance from nearest well-_'__________ No. of compartments-------- �XsS---------Liquid" el?0----- ----Capacity--- ------- ------- Distance o nearesf�lot line:7 Disposal Field: Distance from nearest well___ ----Distance from foundation-- -_ t - --- ---- _�;o Length of each line---------------------- Width of trench_.____.-` ot/0r ,, -- -------- ------ ----- ---- Type of filter. m - ."Depth.of filter. material---_AS------------Total length___.._ ._:- __;---- - -----" I Number of lines_____:_ eial ir Seepage Pit: Distance to nearest well-----J--------------Distance fo'undation------ ......rDistance to nearest lot line_-__- --------- F1 Number of pits--------------------tLining material--------------------...Size: Diameter------_----------------Depth--------------------------------- Cesspool: Distance from nearest well-i---------------Distance from foundation.._- -------------Lining material_______----_---_.-.---------_'_-.-_. Size: Diameter--------------------------------------De th------------------------------------ --- ------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--_-------------- ---.-Distance. from.nearest,buildin❑ g-------------------------------------- Distance to nearest lot line-------------------------------------------------------= ----------------------------------- Remodeling ------------------------ -- -----Remodeling and/or repairing (describe):---------------------------•----------------------------------------• •----•------------------•---------------° Vol -------------------------------------- -------------------------------------I---------- --------- -----------I ----------------------------------------------------------------------------------------------- ------------ ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- a --------------------------------------------------- ------------------ -----I. her 9by-72brfify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinatns."XS, la&wand rules and r gulatlans of the San Joaquin Local Health District. r 4 (Signe -- --- -------- ----------- ---------- -- ------------ ------ ----------------------------------------------------------(Owner and/or Contlactor) By:---------------------I-------------------------------------------------------------------------------------------------------------(Title)------ -------------------- ---------- ----- ....... ------ (Plot plan, showing.size of,lot, location of system in relation to wells, buildings, etc., can be placed on Ar'_everse'�side). A-* FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------C� -20-62-t�-------------------------------------------------- -------- DATE------/4----4-7=---4& REVIEWEDBY-------•------------------------- -- - -------------------------------------- --=-'--------- DATE------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- ---------- DATE------------------------------------------------------ Alterations and/or recd pmendations:-- ----------- --------&............a- a-----------------0--- -4--------A- -4------66--- t-------- --------------- ---------- ------ 7A ---------- - .1/------Ae -- --------- --- --- - --------- ----- ZA ------------ - _.._.E'er_- --- --- -------------------------------------------------- -•-'---------- FINAL INSPECTION BY:---------e'X-�_ --------- --------------------------- Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 13-59 3M 3-'63 F.F.rD.