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FOR OFFICE USE: ------------ - --------- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. 5;;�`5..3 __ (Complete-in Duplicate) Date Issued _� __�f ------_� _- -- - - ----- ----_---- - -.-_--.- 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 install the work herein This application is made in compliance with County Ordinance No. 549. 194P3—Z�U—f� ! ^ I JOB ADDRESS AND TION._U I�4'�----'�{,)-- �� /J' � ��`--�---� ----- -- ---- -- - - -- --- l�,�/ , • �'� �.�_SE'.rll---_ --------------------------- Phone Owner's Name-------- ---- -----: - ----- - Address_ •----- YG r _'._` -. _- � Pit` yam- �� -�,-------- --------------- one------ --------------•---•-•-----•- " -------- - � .".'. .------- Contractor's Name______. . --- ------ P r� Installation will serve: Resident Apartment House Commercial ❑ Tr'`ler %ourt ❑ ,,Motel ' 'Other ❑ 1 ao Number of living units: -_ ._._ Number of bedrooms Number of baths of size .---/a3t•----- Water Supply: Public system ❑ Community system ❑ Privateepth to Water Table _ ft depth of 3 feet- Sand Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soli to a dep ❑ Previous Application Made: (If yes date_..___---:---.. - ) No New Construction: Yes to [] FHA/VA: Yes�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: � I (No.septicrtank ortcesspool_permit+edTif;public ewerris_axailabie within,204,feef.�� Septic n : Distance from nearest well.. "".Distance from foun ation -- -. ria l .._ -V-12 ----- No. of compartments______ l- - Size__' -� rx Liquid depth---- /fir Capacity--/ F k, __ Disposal . --..___.Distance to nearest lot line___ ""___ _._.eld: Distance from nearest well- from foundation_____ ,,; �f c _.Width of trench-- - ------------------ Number of lines------- L ngth of each line__ __ '-_- = -- ----;� Type of filter material-----)._�2 _Depth of filter material.._. �L - --_-Total length____= ?__________________________ Seepage i Distance to Weare t well__1.W-----_._Distance m f undation_____�_ _fl___.Distance to nearest lot line__. "__!.-_._ !� Depth-,- Number of pits... Lining material__ ��. Size: Diameter23--...._.___ 110--v ------ I k � �' Cesspool: Distance from nearest well ...___-__.__.__Distance from foundation.................. Lining material-_ _;_____._----....___________..___ M1 F1Size: Diameter- -- --------- ----- ----- ---------Depth------- --- ------------------------------- -------.Liquid Capacity gals. Privy: Distance from nearest well...____________________________ ..Distance from nearest building___.I-__,..__--_..________.__...___... ❑ Distance to nearest lot line --------------------------- --------------------- f _ 0-•----------------------------"--------- Remodeling and/or repainng (describe):... _---�--�-------- r 1 F ----------------------- ------ r ---- --- - f _ - _ p P -----------pp---------------------------------------------- ----- -------: =- F'----------------------------------------------------------- at ---�;---------------------------------------------- 9 I hereby certify that I have re ared this application and that the work will be done In accordance with San.Joaquin County ,ordinances, state la d rules and r ulations of the San Joaquin Local Health District. t: . (Owner a gdr�C?o�ntracfor) (Signed ...�Y� l . r------- ----- ----_. (7.i+1 = } — - — - • ,r %�.-;� w 81 (Plott p r bowing size ot, locatl n of system in relation to wells, buildings, etc., can be p1 ed on rev ses�de. it t FOR DEPARTMETJT USE ONLY ` --------- DATE------ _ ....... - - . .....' -- .--- ------ APPLICATION ACCEPTED BY---- _:::—;—::- ------ - "� �-��= REVIEWED BY-------------------------- - --- - -------------- ----- DATE-----} _ BUILDINGPERMIT ISSUED-------- -- ------------------------ ------------------- ----- ---------------------------#-------- DATE------ ------------------------------- --------------------- Alterations and/or recommendations------ - --------- --------------- --------=ti3------------------- ---- --------• ------------•------ ------------------ ----------- ----------- ---------- ------ ------------------------------------ ----------------- ---- --------- ----- - / R / �- —7-� FINAL IN5PI CTION BY:... - Date.-: .:_ :-:.- SAN JOAQUIN-LOCAL,HEALTH D}ISTRICT i 1601s.Hazellon-Ave. 300 West Oak Street J ` 124 Sycam a Street• 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California �. E.H.9 2M 1-67 Vanguard Press i'