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FOR OFFICE V, of--- --------- --f -, �j_-_.-.. APPLICATION FOR SANITATION PERMIT Permit No. --(�-..... ........-.. , (Complete-in Duplicate) 3 -� -------- - -------- --------------- ---- -- .. - = --�---��--••------ This Permit Expires 1 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. --------------------------------------- ------------------ JOB ADDRESS AND OCATION____J_______ - PhonelW Owner's Name - ------ ------------------------------------------ Address ------------------------ ---- Address-----•--------------1----... � 4. ,01111o'� . �. 2 .. - Contractor's Name--------------------------_-- --- ------------------- -- {- Z` ----- -----------------C/------- ------- ----------------------------------------------- Phone_-_-__ ---------------•----------.. i Installation will serve: .Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I---- Number of bedrooms_ Number of baths_______ Lot size ----Ae ._ - --!---------------------- Water Supply: Public system [Community system ❑ Private 0 Depth to Water Table- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_--------_-__--. ) No New Construction: Yes R�'No ❑ FHA/VA: Yes j No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Tank or cesspool permitted if pub'c sewer is available within 200 feet.)/ Septic Tank: Distance from nearest weU__ L-__Distance from foundation_-./to-__-____--.Material ___ --------- __________. �� p ,,�� '�7 r � -ti ---Liquid de -- .........Capacity---��-Ole Dis osal Field: Distance from nearest well../- 60 ._D stAcei from foundatio ___l-- ___-_-Distance to nearest lot line_____-_____ No. of compartments exat C. Number of {fines______________ Legglth of each line__ - -�-. --------Width of trench._..___ - - Ir f•------------------ per, !LIX Type of filter material __._ p of filter mater�al_____r4_..._--:-Total length........ __________________ \I t n to nearest welL .D._I1 Distar f / /J� e th See Pi Dis a ce !� e,. ce fr f undatien_-_� _ ____._.Distance to nearest lot line__._.____._ Number of pits-_- __ Lining maternal_.. _ _ Size: DiamEter_- _._., Depth--_- '�_____ ______________ t 4 Cesspool�� Distance from nearest well -----------------Dist�nce from foundation------------_____-.Lining material____-.___.__-._____-__.___-____ Size: Diameter_ _. ....De th----------------------- - --------------------------Li Liquid Capacity -------------- als. Dept .1 - q Y - -- -- Privy: Distance from nearest well-_-____ r______------________, N......---Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----'------------------- -------------------------------------------- ---------- ----- ----------------------------------- Remo eling an or r pairing (desc ibe):_ - - -- - --- -----------------------------------------------Y {------� ------ - ------------------------------------------- --------------------=------------------------- -•---------------------------------------•------------------------------- --------------------------------------------- --------------------------------- 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 regulations of the Sa Joaquin Local Health District. (Signed)__ / [Owner and/or Contractor.) ---- --- - -- l BY� -------- ----------------- ------- ------- ---- ---------------------------------------(Title) ----------- ------- ------------.._...._--------------- (Plot plan, showing size bf lot, location of system in relation to wells, buildings, etc., can be ,placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -------------------------------------------------------------------- DATE --�7_ lSa _---- REVIEWEDBY------------------------------------------- ------------------- ------- ------------------------------------------------ DATE-------- ----- --------•----- ---------------------------- - BUILDINGPERMIT ISSUED-------- -- - ------------------------------------------- ------------------------------------------ DATE--------- ------------------ Alterations an or yG,�gmdations:__._._ _ _.- -- - -- ------------------------------ •'�-J' ' Ufa` °_- - - --- --- --_--_ , i- .-- C ----- ----- ------------ -------------------------------- ----------- y / J� - --M---O ---------. ------------------------------ ------- -----A-fes.- --/j- , - FINAL fNSPECTION BY:..--------- / -------------------------------------- Date- --- 5 . � - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California - F Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press tit i