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FOR OFFIC�,USE: Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) -------- Date Issued ..... j1his Permit Expires 1 Year Fionri'DatWlisued- --------- - ------------------------ ---------------------- Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in complia6ce ;with County 0;O' ante No. 549. H --------- LOCA N Z -------- ----------- -----------S -- ----- JOB ADDRESS AND WN.... /Zs /6 Owner's Name---- - .. .... -Ar..........�le t....... . ...... ------------------------------------------ Phone 11 44" — 'L T Address----------------- - - ----------------- -------•--------------- ------------------------ Phone__Ae -47,19 9 7 r4, ---&z.0-------------------:------------------------------- Contractor's Name F Trailer Other El I T' iler Court 0 Motel E] Installation will serve. Residence Apartment House El Commercial - Number of living units: Number of-bedrooms: ._2--_'_Nurnber of baths ------- Lot ^'J______________ .size ...... Water Supply: Public system �Community system [I Private E] Depth to V7.t;r Table W".d_ Character of soil to a depth of 3 feet: Sand E] Gravel Sandy Loam E] Clay Loam 0 Clay 0 Adobe ( Hardpan 0 Previous Application Made- [if yes,date----- --------) No [:]' New'Construction Yes [-] No FHA/VA. Yes [] No,5 TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool'permitted if public sewer is available within 200 feet.) .4 _______--__._.._____. ....____._.____s_ Distance from�nearest well----------------Distance from foundation--------------------Material_____-. Capacity... ------ Capacity---No. of compahments------ -------------------Size-..--------------------------...Liquid dep.th-------------------------- 119._-Distance to nearest lot line--- ------ DiToosal B018-1 Distance from'nearest well Distance from foundation.... Width of trench----:4-11---------------------- Number of lines--------/----=-------------------Length of each line------- ............. 7 Aad Type of filter maferial_Rar__.�.Q.Pi-------Depth of filter material.-__. --------Total length--------- -------------- Seepage Pit: Distance to nearedwell-11-wr-------------Distance from foundafion----0-0--------Di5fance to nearest ]of line__.. Number of pits-----/--------------Lining mate ------ Size: Diarn.efer____.,1ff__".__Depth------- --------- Cesspool: Distance from' nearest wel[------------------Distance from foundation - ____-.__._-_..Lining material------------I-------------------- 171 ----- Size: Diamefe" -I ------------`Depth-------------------- ------------------------Liquid Capacity------------• --------------gals- ------------------------ Privy: Distance from nearest well---------- ----------------- Distance from nearest building._--_..____._______-________.____________. ❑ D nearest ------- -------------------------- ------------------------------------- Remodeling and/or repairing (describe :--------- ------------------------- .........------- ------------------------------------------------------------ ----------------------------------------------------------- ---------- -------------- ------- ----------1�------------ - --------------------------------------------- X7 ---------------------------------------------------------------------- ----- ----- --- --------------------I---------------------- ------------- -----------_---- ---- ---------------- ------ --- ------------------------------------------------ --------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ 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 rules and regulations of the San Joaquin Lo6al Health District. ----------- -------_jQwnw=and/-er Contractor) ------- -- 41) -------- --- --- - ------- (Signed)-j/0- ------ ------------------------ -------------- ---------------- building -- -- (Title)--, ------------------------- ------------- -------------- By:----------------- -------- -- ------ -----I b iIdin__g__9.__ can be placed on reverse side). (Plot plan, showing size of lot, loq`afion of system in relation to c., j. FOR DEPARTMENT USE 0:NL� APPLICATION ACCEPTED BY--- --- --------------------DATE__/�4_— -------------------- REVIEWEDBY--------------------- _-----------------------------------------------------------------I--------------DATE----------------------- -------------------------- --------- ----------------- DATE--------------------------------------------------- BUILDINGPERMIT ISSUED---------:_---------------- ---------------------------- --------------------------- Alterations and/or recornmendations.:_'--------------------------- ------.-r-2---------- ------------------------------------------ -------------------------------I-------- I ----- ---------- ------------------------ -----------'L-----C---- ------------------------------- ---------------- ---------------------------------------- ------------------------ / _ ------- - - ..... -C---- - ----------------------------------------------- --------------- ------w------------- --------------------- --------------------------------:--------------------------------------*---------------------------:--------------------- ------------------- ------------------* ---------------------•----------------- ----- ------------------------------------- - -------------- ----------- FINAL INSPECTION BY:.... --—----�, Date 1_2------- -----------__--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street II 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,CalifQ'nlo Lodi,California Manteca,California Tracy,California ES.9 qEVIBED 0.59 r.P.Cr.2M 6-613