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� 1 --- 1 • / - APPLICATION FOR SANITATION PERMIT '~ Permit No. .2 C1 - (Complete in Duplicate) l --------------- ------ M. r A la motion ,s hereby r- - ---- This Permit Ex fres 7 Year From Date Issued Date Issued ._'/ S into the San Joaquin Local Health District for a permit to construct and ins-Fall the work herein descr,bed. This application is made in compliance with County Ordinance No. 549. + JOB ADDRESS AND L CATION___----- -_.7� 3_ e M * � /�'. t.1-------------------- ------------------------------ Address ------------------- Owner's Name /1f.,J /J� , - --•-------------------- --- G� ------------- ------------- Address_ --•-------•-----• Phone_ - ----------------- - In Installation will serve: Resid M / ----------- ,.� � ---------------------- nce LSI' Apartment House ❑ Commercial Number of living units- ❑ Trailer Court ❑ Motel ❑ Other ❑ -- Number of bedrooms_- "Number of _e--- Lot size ________ __ Water Supply: Public s ste IM �'� _: Y ❑ Communit system Y Y ❑ Private 9?-*15epth to Water Table __.. Character of soil to a depth of 3 fest: Sand ❑ Gravel F-1 ___- {t. Sandy Loam ❑ Clay Loam Clay ❑ Adobe Previous Application Made: {If yes,dote-, ---------------- No ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: � New Construction: Yes ❑ No [-rHA/VA`:tYes 0 No fr�� (No septic tank or cesspool permitted if p blit sewer is available within 200 feet.] Septic Ta O f/ / 1 p Distance fhom nearest we I___ ....___Distance from foundation__- -- No. of compartments_------ Material- " pyx i Size-- .k_ X Liquid depth_.., : Capacity--, __ �' Disposal F' d: Distance f�om nearest titiel ---Distance from faundation/��-----_ - Number of• lines------- Distance .to nearest lot line.___ _-� i rL-- ------Length of each line--- _5r_,'_._-- Widt'n o{ trench--- - -rr . Type of filter maferial____S '� /! p g IM., Depth of filter mater;al_--f�__- ----Total length___ -_-o -- See a e it: Distance to neares� _-__ — .3 r IGR& _____Distance fro foundation 44F. i Number of pits------Z _ e • -Distance to nearest lot line-_f __--_ ...-_.___Lining material___ - nce fil Cess Cesspool: 1 C-.Size: Diameter f�----,Depth_ n. ------------------ ,l Distance from foundation..___-- Lining material_.____.__,- ❑ Size:aD,a Diameter nearest well Depth Privy. . .-----Liquid Capacity-----------------------------gals. Distance from nearest well-____---__--- Distance from nearest building _ ❑ Distance tolnearest lot line ------------ - - -' Remodeling an or repair g (&scrib - ------ .�� --------- aS-r- ��? p .T - /�. ----- `9 ------------------- -------------------------------------------- ------------------- - 1 ------------------------------------ -- ti -- - - i -------------------------------------------------------------- •----------------------------------------------•-------- I hereby certify that I have prepared this application and that the wo"rk will be done in accordance with San Joaquin County ordinances, State la ru �' and regulations of the San Joaquin Local Health District. (Signed)- . ---------- 3Y - --------------- er /or Contractor) s - i - --- - - ' ------ -----1 (Title)------ (Plot plan, showing size of lot, location of s em in relation to wells, b�iildings, etc., can be placed on reverse side). IC I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---l_.-- — REVIEWED �BY _fT. ~� - ---- - ---, - L_-------------------------- ------- ------ DATE-,.---.'� `r- ---------- ti ------- A --------- -....__"._V_ ------------ BUILDING PERMIT --------------- -------- ---------------- ---------------------- f ----- -----, DATE----- ------Alterations and/or recommendations: r / c_ = -- : — .. =- -- -� ---------------- y----------- -------- ----- y ,�' �' C -. ---.--`-=�'.------------------- ------------- ---- --------------- F1NAL INSPECTION BY:..------ .T---.._ _ -- ............... l 1 ^ = ate SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,Calffornia 20$West 9Th Street ' Manteca,California � Tracy,California