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FOR G-3FFICE USE: ----- ------- --- --- ---- ----------------------------- ----------------------------- ----- ------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. . ... ._....... .... ---------------------------------------------------- �# (Complete in" Duplic ted / ` Date Issued ____�� __L, --------- ------------------ - ---t ----. � Year From Date Issued I _ This Permit Expires.1 , -. 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, i JOB ADDRESS ANDI LOCATIONATS _ 6-------A-V-Ems.__--_-------• -• ,� r Owner's Name �_a�_vt�4. _ } -------------------------------------------------- ------- - Phone------------------ -- Address-------------------/43- •-----IAI `'�__0-Ni----------•-------t- I----•----------••---- --------------------------------------------------•---------...----•---••-•----._...------- Contractor's Name...-i-...0.VVN_aF—__-...................... ------------------------------------•------------------ ------ -----------------. Phone--------------••--------••--------- t Installation will serve: Residence ❑ Apartment House ❑ I Commercial ❑ Trailer Gciurt-gr<otel [I Other ❑ Number of living units: -_ [.--- Number of bedrooms -fl—Number of baths ---/--- Lot size ------�1Z__K....�3 C__�______________ Water Supply: Public system El Community system E] Pri vate�Depth to Water Table __g_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sa dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [❑ Previous Application"Made: (If yes,date____________________) No New Construction: Yes'gj-`I�o ❑ FHA/VA: Yes ❑ No a• TYPE OF INSTALLATION AND SPECIFICATIONS: L i�► (N(: septic tank or cesspool permitted if Tubltc sewer is available within 200 feet.] Septic Tank: Distance from nearest well__ (?_. _Distance from foundation--.-- .__._._.Material-----/?,lla]D{111 C1 Q�------------- p - - _?__X_'j__A_5---Liquid depth---- - : P jt�5 N6. of compartments _r�_ _____.____Size$_ ��-.___ Capacity i Disposal Field: i.Distance from nearest well-__,5ju_ _Distance from foundation.___--j_. ,4__'__.Distance to nearest lot line--- Number of lines---------_-- ----------Length of each line----_,"�__._..�_____.Width of trench------!;;�Y------------------__ Type of filter material___ C� -_____Depth of filter material___.f _.---------Total length--------- /� Seepage Pit: ADistance tolneaFest'�vell-� -------------Distance from foundation_-------_-_+-------Distance to nearest lot line--------------- • EJ Number of;pits----------------------Lining material_.-._...._._._..______.Size: Diameter---------------------Depth------------------------:-.------ VI Cesspool- k Distance from nearest well-----------------Distance from foundation___.____-.1_ _.Lining material__ ---------------------------------- El ___- ...._-_-----._---_-- ❑ *Size: Diameter---- 4 -------- -- -------------------Deth--------------------------------------- -- - Li uid Ca acitY ------_-. als.. Privy: ' Distance from nearest well ------------------ ----------_-----------Distance from nearest building---------------------------------..-_----. ❑ Distance to nearest lot line..........._--------_------ --------------------- I I � T Remodeling and/or repairing (describe]:._s___._______________________ 0 - --•t ----------------------------------=-t-•----------••--`- "a--•---- -- _________________________________w_ ________________'____._--------_-_-___�__-_-_---__---___-_-_--_--___•-_.__-________----_--.__-------_-___-_- I! ___________________________________________________________________________ _.--_. -------------------------: -----.---__-__--------_._----------------------------------------------------------- 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 reguula�tio�ns of the San Joaquin Local Health District. (Signed}._i.�'°�;?l?<<' ._. f4_ --------- " r, 1 --------------------------------------------------------------(Owner ant/or Contractor) B f - Y. - �---Title----------�- --v-=---- -•-- ---- -.- --- ..-... . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t4 FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BYr-------�l -1.Q. „-"`: DATE-----/'r 'r,R,a• - REVIEWED BY ------------------="-----. ---- _ ._ 0 -------------------- _ee...... _ ` -------------- ------ DATE------ - BUILDING PERMIT ISSUED------------ -----------=="-=------------------------- --------- • -ObATE--------- ---------------------------------------•------ Alterations and/or recommendations:------- --- `--=---=--- ----- --------------------------------- `----------------------------------------------------------•------------------- ------- ---- -----1 _-__6 __- ' ^r `a.: >ervra acr A------nape res------- ------------- ------------------------------------ ---------13 _4�_ i.,. A _{r - ----Zziw_-`� ------- ---------------------------•--------------------------------------- ------------------------------------ ----------------- ------ ---------------------------- FINAL INSPECTION BY:. Date - ~ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,Colifornla Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3•'63 F.P.CD.