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FOR OFFICE USE: ------- APPLICATION FOR SANITATION PERMIT Permit No. _csz2_! � - - ------ (Complete in Duplicate) - ---------- Date Issued -f � � T .. --.--- - "___---.-_- This Permit Expires i Year From Date issued M Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work h rein described. I This application is made in compliance with County Ordinance No. 549. � � JOB ADDRESS AND L CATION__ 'J� - �1it'�� is/ 410-'---- � .-1�� " `� �� r j Phone me_ - -J !l�r � ------------ Owner's N _ �19 Z_ � ir- 10. Address_--- Contractor's Name------Apr_rZD":77�c 0 ___ ---------- Phone-----------.----------------------- - Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/._ Number of bedrooms-3--_ Number of baths A__ Lot size _4?4+-Adr,,P�-------------------------------- Jr Water Supply: Public system ❑ Community systemprivate;❑ Depth to Water Table lur- ft. t Adobe Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [ lay Loam ❑ Clay ❑ ❑ Previous Application Made: (If yes,date----------- --------f No g "— New Construction: Yes 0�" No E] FHA/VA: Yes ®..—No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.)! /fir AY .___-_--_. Septic Tank: Distance from nearest well /-___Distance from foundation" __._._____Material- "�?°,L�v ----- 0f1/ No. of compartments Size.' �.- __Liquid depth-- :_ /. -/-- ----Capacity- - ----- ----- ----- f P/_.Disfance l�-r-_-.Distance to nearest lot line;_l_bis as� ie d; Distance from nearest wellfrom foundation._. __ s Au i�I Number of lines---.--/._--_-_ ------.._---_-. Length of each line.___ _- __f Width of trent ._.�_________ ____________ f � ----�----- �;J�/ Type of filter materia ---Depth of filter material__/�.-_..-__Total length--.- Pit: Distance to nearest well______---------------Distance from foundation--------------------Distance to nearest lot line----__._--_--.-. ❑ Number of pits----------------------Lining material--------- -----:----- --Size: Diameter--.--------------------Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.------.-----__-.-.Lining material----------..______.--.-_ ____-_-_-. Size:.Diameter .... ------- --.--=.Depth--------------- Liquid. Capa�Y _ ,._-.__..gals Privy: Distance from nearest well------------------------------------- -'--------Distance from nearest building----- Distance to nearest lot line--------- ° ---------------------------------------- -- r � "" ' 1 Remodeling an /or re irin � escribe):._ -- -.�.'�-------��_�`_"�__��---------- -- �-�-------�- -�_��-----• G ` ' ------------ ----------------------•- I _,-;r ► ------------------------------------------------------------------- -= ---------•------------- -------------------- ------------- - --- --------- ------------------------------------------------------------------------- ------------------------------------------------------------------- - --------- 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 rulesand regulations of the San Joaquin Local Health District. I (Signed)------------------------ ff ,--- �6< (� — --- w ---------- '7n—.- /or Contractor) ..► ( ------�--------------------- Title By: ------ ---•- - {_ } 1 (Plot plan, showing size of lot, location of syst i re ation to wells, buildings, etc., can be placed on reverse side). i I FOR DEPARTMENT USE ONLY, - APPLICATION ACCEPTED B ----------- --- ------------- ----------- ---------------------------------------------- DATE------"-� '� ----------------------- REVIEWEDBY----------------------- ---- -- --------------------------- DATE , BUILDING PERMIT ISSUED-------------- .-- DATE-----------------t -'--` Alterations and/or recommendations:------- ----------- -------------- --- -------------------- ------------------------------------------------- ;---------------------------------------- - - --------- -------------k-------- >--------------------_---------- -------------------------------- ------------- ---- ------- --------------- --------- • - •---------------------- ------ )----------- ),-•-,.----------------------------------------- ----------------- ------------------- ----------- -------------- -----=�_-.._—"------------------- ------------------------------ -------------- --------- ---------- ---------- FINAL WSPECTION -- ----------------- Date- -:31-G� A OAQUIN LOCAL HEALTH DISTRICT _.k. E - _ 160 1 . Ave. 300.West Oak Street H : 4 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ° Manteca,California Tracy,California F.P.CQ.