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F%./[\ lal I . 1%_L - .4� 1 -------------- 4 Permit No. - -- APPLICATION FOR SANITATION PERMIT ---------- r N> (Complete in Duplicate) ---------- �N ......... .1 . I ........................... I ........................ This Permit Expires I 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. 1.4l. -V. 47- 6er_V1i2_C- CM7'119A JOB ADDRESS ANDF_1V -------------------------------------------------------------------------------- Owner's Name_ ......... ------------------ - ---------------------•-------•---------------- ---.-. Phone_87_-�5 _V -Z- - ..................... _ ........ _ Address .......... CS.............. ------- ........................................................................................_•---•---•---......... " '1 -0 ....... Contractor's P13- IP -0,6- t.5.- t+. ------- *..,5 -0. Ij-'s ---------- ............ I ............... Phone ... Installation will serve: Residence [-] Apartment House E] Commercial ED Trailer Court E] Motel [] Other 19.1 Number of living units: -------- Number of bedrooms .19!�- Number of baths ..;0'&Lot size ------------ e� -------- Water Supply: Public system Ej Community system El Private [j4- Depth to Water Table .4.d_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam El Clay Loam R' Clay 0 Adobe E] Hardpan 0 Previous Application Made: (If yes,dote ------------------- ) No E?New Construction: Yes _�No 0 FHA/VA; Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ja Septic Tank: Distance fromnearestwell-P-610 ...... Distance from founclatio n . .. ............ Moter-Cd --- ----- - ------------------- �4 N O. omens___'V Nf compartt�: --------- ._ _,5 Size_cSX_-__X--Liquid depth _Capacity ... ._r ----- , Disposal Field: Distance from nearest well.40P.". Distance from foundation--,.?,jP.-# ---_...Distance to nearest lot line...:?.. Number of lines ------------- I ----------------------- Length of each line ----------- fQ --- ---------- Width of trench - Type of filter Depth of filter material ."_____.Total length .........................'o..'_.._._. Seepage Pit: Distance to nearest -_---____Distance from founclation-2-0 ... ...... Distance to nearest lot line.. -P -L-0 .... .. k Number of pits.......:....._..... .Lining material..' X#5�q-&--_Size: Diametpr��-._'.� ... Depth ........... A - Cesspool: Distance. from nearest well_________________ Distance from foundation -------------- I ------ Lining material. . ..... ......................... F1 Size: Diameter----------------- ----------------------------------------- Liquid Capacity -----------------•-•-------.gals. Privy: Distance from nearest.weli`______________________________Distance from.-nearesi building............__..___...__._. ................. 0 Distance to nearest lot line.--------.... ----------------•-------------------------------------•- . . ................ ............... Remo'deling and/orj7re`pairin-9 -------- -------- ....... ------- rf*.# ------------------------ -------- I .......... ----------------------------------- .... ............ .................................................... ..................... - ------------------------------------------ - ---- - --------------------- --............. ............ I ------------------------------------------- ............................................................ - --------------------- ....... ....................... ----------------------- -------- .......... ..... I I hereby certify that I hive prepared *this —application 'and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reglulationtlof the San Joaquin Local Health District. (Signed).... -------- ego:., --- q� .................... a ---- --- I ------- I ------------------------- ------------ ! ..................... (Owner and/or Contractor) By:-------- ---------------------- ...... -------- P—o—i . .... , ........................ (Plot plan, showing size of lot, locati nela't-ion to ystern in r wells, buildings.. etc-., can be placed an reverse side). APPLICATION ACCEPTED BY ----- L,/- _ - ------ --- __6ATE DATE._... ................ -----`--•---------------- -•---- BY .......... t -------- i ----------- ------------------------------------------- - --------------------------- ------------- DATE.'....... _...............-•-•.............. ------------- BUILDINGPERMITASSUED .................•---I-.-----------------------------_-. ---- _ ..... ..... ----------------- DATE._...------ -------- --- - -- ------- ........---•-----..__.. ns and/or reconimendations-.- 7 Alterations ........................ ............ ; ------------- .. ................. ........... 19 --- ----------- - - ------------------ ------- -je- %. .......... ............... .......... — --------- ............. ........................... ........ ........................ ............ ........................................................... ...... ........................................ ....... . -------- dF- - ....... ..... .............................................................................. ------------------- ................... .. .................................. : ........................ .. .. 0, .. - - t . - 1% 1ma y - — — --------------- ----------------- ----------------------------------- FINAL INSPECTION B fANf '-JOAQUIN LOCAL HEALTH DISTRICT 0 West 1601 1. Hazelton Ave. 0 West Oak Street 124 sycamore Street 203 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California Ea 9 REVISED B-59 3FA 3 -*63 F.F.00.