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FOR OFFICE USE: ------------------------- ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .......... ----------------------------- -------------- ------------- ------------------:----------------------- (Complete in Duplicate) Date Issued ---=. -- ---------- ---------------- ------ This Permit Expires 1 Year From Date Issued, Ds`I-f 190-0 2- ------------ Application 'is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This aplication is ma�c[ jp ecp Viance with County Orclinance�No. 549. X4f:F__"0 LAP-:. K,AN VIF - 1716 41 -------------------------- �_ey e 15�o�q JOB ADDRESS AN LOCATIONA/ePLAF--------------------------------------- I------ - -------'----=-------- ---------- Owner's Name_____ Z1,ff_7-v------- ....... -----ql,41� -------------------------- -------- Phone------------------------------------ 4 - ------ _-------------W ------- --------------/� Address.......O'da)P-7-------k ___S. ......—-------S-7' _7_�//-------------------------------------------- I'V1971P ----------------------- L --- I I Contractor's Name-------------------- ------- i-------7-7/&C—------------- -------------------- Phone. tj Motel 0 Other Installation will serve: Residence E] Apartment House E] Commercial [If Trailer Court El Number of living units: -------- Number of bedrooms --------INumber of baths .Lot size ---/qc/p _.e-- ------------------ I -f ZIA ft. Community system 0 Private 0 Depth ter table Water Supply: Public sysfern/ T to Water I f feet: Sand [] Gravel [I Sandy Loa Clay E:] Clay 0 Adobe 0 Hardpan 0 Char�cter of soil to a depth 3 f Clay m rn�< , I Previous Application Made: '[If yes,date----..--. No 0 New Construction: Yes .E] No X FHA/VA: Yes E] No El TYPE OF INSTALLATION AND SPECIFICATIONS (No septic tank or cesspool permitted if public sewer is available within-200 fee+.).l -septic-Tank- Distance frZm nearest well-----------------Distance from foundation-.------------------Material------------------------------------------------- /VY No. of compartments-----------` j--- ---Size----------------------------=---Liquid depth----------------- -------Capacity------------e -4N S ....j-. Disposal Field: Distance from nearest wel17;�7P---------Distance from foundation--- -- -------Distance to nearest lot line-% .... - W _5_1_ _:_ Length of each line--.- Width of french._,,;�Y....... 7 Number,of �ines----- of filter material---- R----Depth of filter material----/8�-----------Total length-------------------'SQ------------ Type *1 - - 7_ line---5------7�'__ --_----Distance kF,��n foundation----L5A-/_._Disfan I ce to nearest lot Seepage Pit: Distance to nearest well/Av Number of pits-_--- ------------- --Size: Diameter---31,8............ ------------------ "s � Cesspool: Distance from nearest well------ -----------Distance from foundation------------------- Lining material'___.-__---____.--___._____--______- ---------------------------� Size: Diameter------------- -------------------------Depth------------ -----------------------------I--------Liquid Capacity gals. Privy: Distance from nearest well----- ------------ ---------- --------Distance from nearest building------------------------------------------ ------------------------------------ ------ 0 Distance to nearest lot line--- ---------- ---------+ - - --- ........f--------------------I------------I------------- repairing (describe):--- 0--------- -------------------- Remodeling and/or r / I . 7 ------------------------------------------------------------------------ ------------------------------------------------------------------------------- --------- -------------------- ------------ --------------------------------------------------------------------------------------------------------------------------------------------------- -------i--------- -------------------------------------------------- -------------------------7 r- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ I here ertify that I have prepared this application and that the work will be done.in' accordance with San Joaquin County regulations of the San Joaquin Local ordinanc s, Stat laws, and rules and Health District. (Signed ------d-Z------ -------(Owner and/or Contractor) ------ ---- - -- f�- - - - - - - -4------ ---------------------I-t- F1 —------- ------ ----- -----(Title}- ------ -------------------------------------- By:--------------------- v (Plot plan, showing size of lot, location of system in relation to wells, bu dings, etc., can be'placed on reverse side). FOR DEPARTMENT USE ONLY 3 APPLICATION:ACCEPTED ----------------------------------------------------- DATE - _T_'G ------------------------------------ REVIEWEDBY-------- I------------------------------------ -- ---------------I------------------------------------------------------ DATE----------------------------------------------------------- I I I -V BUILDING PERMIT ISSUED------- 1�-------------------------------%1-----------I--------------- -------------------------- --------- DATE--------------------------- --------------------------------- Alterations and/or recommendations----------- ------------------- -- --------------------------------------------------------------------------------------P---------------------------------------- ----------------------------f------------------------------------------- ------------- ------- ------------------------------------------------------I------------;;------------------------------------------------ ti ----------------------------------------- ------------I_�:�--------------------------------------- --------------------------------------------- ------------------ --------------- --------------------I------------------- ------------------------------------ -------------------L--------------------- ---------------------------------------------- ---------------------------IN----------------- - ---------------------------- --------------------- --------------------------------------------------- ---------- ------------------------------------------------------ --------------------------- ---------------- FINAL INSPECTION ----------- Date..... 4.3--------------------------------------------- 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 S-S9 31A 3-'63 F.P.CD.