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FOR OFFICE IfSE: ---------------------- _ ---- ----- _ _---- - --------- APPLICATION FOR SANITATION PERMIT Permit No. ........ ------- _ -------------------- - - ----------- ------------- ------------- (Complete in Duplicate) Date Issued ---- � r -------------_._. This Permit Expires 1 Year From Date Issued /97-400- 0/, Application is hereby made to the San Joaquin Local Health District for a permit to construct and -install the work herein described.. Lk This application is made 'n ompliance with County Ordinance No. 549. T3-rv,/ i P1 ivV ��CR t-O N k JOB ADDRESS AND LOCA l tq. --- I�-F Ti �`� -"--- A- 1�-- -----�_Rft -KS_'__.. � � E 4.1 _-�1-_ Phone------------------------------------ Owner's Name---------------------- -------- -- -- �--------------------- —-- - y -----------------------•--------------------...--------------•- Address----------------- _/-------------- /. ��--------------t----� C Q - _`_ - Phone------------------------------- U, -- -------------•---- Contractors Name------�_1111 _M�----------------- --�--------------------j-- - - ------------- Installation will serve: Residence 'Apartment House ❑ ci iil/ler Court ❑ Motel ❑ Other ❑ Number of living units: _. ___._ Number of bedrooms 3-_€ umbber aths _1..._ Lot size ----- -./4��-�C�' -------- Water Supply: Public system ❑ Community system ❑ Private Ua-"Depth to Water Table __, 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 [�`o-❑ FHA/VX Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,,or cesspool permitted if public sewer is availa6 a within 200 feet.) Sep{ic nk: Distance m nearest welL__S._ f__Dis ane ifrorriifoundation"'._ _""".Ivlaterial__�� _ ----- No. of comparfiments______._- ----- © ,_ Ct�__X- --Liquid depth_.-i __-Z�..--CapacitY . --=Size's X Z N, 1C-._-_---{Distance to nearest lot line--i�.__.. � q Disposa field: Distance from nearest weii---�_.___.Distance from foundation__. . Number of lin -----------/- \ -'I- g r -� Width of french -��// 1 -Length of each linef ----------- ------Tota! :length } ll e---- Type Y _r;Depth of filter materia�, ', Y g / " T e of filter material.___ _. ��-� � � �. IDistanc :'to/nearest lot Seepage it: Distance to nearest well-----a�_�.. .Vstanc _from foundation____ __ _____ _ EA Number of pits.__-__ :---�____Lining g,material_P_Q_t __.Size: Diameter__ :1---/r i {f".- E Cesspool: Distance from!nearest well_-__--_ _`Distance from foundation-.:______-_. _...Li ing materia!_____________________.._.__.._._ .[' ! ❑ Size: Diameter s------ --------------- -----------bepth f. _�i J�1 iii = Liquid Capacity --------------------------gals.; N ____..D.istance from nearesfbuildin Privy: Distance from nearest well____________________ --- g ❑ Distance to ne8rest lot line---- _-------- - /- ------------.---- -- - --- - Remodeling and/or -repairing [descri4�e :__t4 _fn�D�1�(t - " -- ---------- -- '� F3- ' l3A-ciKFt_ +-- .. - -�--------t�I--•------1 C------------- -Ula-T-A----- -w�1AI�b-------`C-'1�-------�s------- ''� R _ �1� J�C C. {'" =� ( ,�% " i3ic __ t r ntE -- ---- =� � 1 --------------------------------------------- ------ I hereby rfify-#hat l'heve prepared'this"application=-and tat he work will be done*Inatcordance with San Joaquin County ordinances, State laws, and rules end regulations of the San Joaquin Local Health District. r ., r (Owner hand/or Contractor[ gy y , Twnio� - (Title)(Plat plan, showing size of ot, loste in relat on to}wells, buildings, etc., can be placed on revers side). FOR D EPARTMENT USE ONLY APPLICATION ACCEPTED BY '-- " DATE-- •- •� ------------------ ---- ------- f - DATE_---- ----------------•------------------------------------ REVIEWEDBY------------------------------------- - -- ------- -- ------------- ------------------------------------------------------- BUILDING PERMIT ISSUED------- ------ ------- --------------------------- DATE--------- -------------------------------------------------- Alterations and or.recommendations: -- -------- �` ti r ------------------•------------------------------------------------ ------- ---------------- --------------------------------- 1 ----"--------------------------------------------------------------- ________ _________ ____ _____i ------ ---------------------------------------------------------------------------------------------------- FINAL INSPECT IQRi—B .. --- - - ------------ ---------- ---- Date----------- ------------ - ------------------"- i SAN JOAQUIN LOCAL_ HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Y Manteca,California Tracy,California