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FOR OCE USE: /� 'et 3 A Permit No. ........... 3 . ------_-`------ "/Gl- _-_-- APPLICATION FOR SANITATION PERMIT � �..... (Complete in Duplicate) ----------------- This Permit Expires 1 Year From Date Issued 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 LOCATION ��Q 119 Yzir-----------------------------------------------------------•---...----•----•-••._. Owner's Name ----------- ------------------------------------------------------------------------------------- Phonelx�.9..16.=490-- Address-------------------• -•----•-------......................----------------.............................................-.--------_---------------------•-••----------------•--•----- -'. .-� .. p c�QiJ/s'.... ' �'E------.............................. Ph n- - ... ❑ . --.•---•- Contractor s Name.....-......�.!�-...,�1.�.�ISi 1.rT.h`.-. .��.Q� Installation will serve: Residence Apartment House Commercial Trailer Court Motel Other Number of living units: ---/.. Number of bedrooms __2_, Number of baths 1.... Lot size .C'---------------------- Water Supply: Public,system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to ar dep#h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe rV Hardpan ❑ V l Previous Application Made: {If yes,date--------------------f No e New Construction: Yes 0 No 5?r FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S,-ptic Tank: Distance from nearest well............... Distance from foundation---------------....Material-------------------------------------I........... ❑ CIISWAO No. of compartments----•---------------------Size--------------------------------Liquid depth--------------------------Capacity------•--............. Disposal Field: Distance from nearest well-----------------Distance from foundation----__-.--_-.--.-.Distance to nearest lot line................. ❑ N� Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material,.__.---------- ._Totallength.......................................... Seepage Pit: Distance to nearest well--1110YVe---Distance from foundation---'1iG7__?.......Distance'to nearest lot line--30...... 14 0XIM"'i3Number of pits.....--1•----------Lining ------Size: Diameter- -. Depth ..-__.-_.- ..... r91121> - Cesspool: Distance from nearest well................Distance from foundation-------------------.Lining material---.---_.-.._----__.--_------_.------ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building--------_-.__---____--___-.-__.--------.-. ❑ Distance to nearest lot line----------------------------------------------------------------------- -.......•-••--_----------------------------- --------------------- Remodeling and/or repairing (describe):_.__,009.o0t7_--.-.a/ /.131 QE......-----.eC.X_ -------tPi;CT.W-'--92-.I..... ......... 4 --.---•-------•------------------------------------•-•--__-...-___----•-__•__----•-___-_--__----___•_------•__-----___•--••--_-_--....-__---•-__-----•--•----_--__------•---...--_____---•-_-_----------------------.-.--.---- I hereby certify that I have prepared this application 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. (Signed)..•----..-_. !---e--V ,V_X------21 '-------------------------------------------------------------(1Owner and/or Contractor) B �� ----- x (Title) 7 Y• { )-------- (Plot plan, showing sire of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR TPARTMENT USE ONLY APPLICATION ACCEPTED BY---- DATEJ z -..-... REVIEWEDBY------------------------------------------- - ------------------------------------------------------------------------------- DATE------------•---------------------------------••------------ BUILDING PERMIT ISSUED-------------------------------------------------------------•---------------------------------------- DATE----------------------------------------------•-............. Alterations and/or recom end'ations:-_.__-.-_-__- ' - -...._-- --------------------------- ----------------- FINAL INSPECTION BY:---- C_ ----------- --- ----------- Date.- 6-- Z----------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REMED 8-59 9M 6-61 ATLAS