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FOR OFFICE USE: -- ------------- ------------------- P -------- ------------ APPLICATION FOR SANITATION PERMIT t No. ------------------------------------------------- ermi - ----- - -------------- ------- ---------------- (Complete in Duplicate) -Date Issued A/—------- ---------------------------- This Permit Expires I Year From 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. 0 Z f37 �r*�kG za-Z---RA--- ------ ---------------------- JOB ADDRESS A�,V LOCATION -------------- . Owner's Name--A4T --------- Phone__ ------I--------------------- Address �f 21 _? - -------------------- ---------------------------------------------------------------- .......... --------- x—-C), --------------- Phone---------------------------------- Installation Name--.-- - - ---------------------- -LA-- ----------- El Motel F] Other 0 Installation will serve: Residence Apartment House n Commercial El Trailer Court _j C, Number of living units: J--- Number of bedrooms -.?-- Number f baths 2,_ Lot size -----Ant-%..... ---------------------- T Water Supply: Public system 0 Community system El Private Number to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand E] . Gravel [:] Sandy Loam [j Clay Loam [] Clay Z_ Aclobe❑ Hardpan Previous Application Made: (if yes,date--------------------) No F1 New Construction: Yes E3 No 0 FHA/VA: Yes El No n TYPE OF INSTALLATION AND SPECIFICATIONS: e i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance m k: Distfrom 'nearest well__O�.........Distance from foundation-_._- -------------------- 1 '2-&, �e No. of compartments------ ---x -- ------ -p- --------- ----Sie-q-'/,' Y'X--- Liquid dep�h----V-- --------------.Ca ----- lot line S----r Dispos on-----JA.........Distance to nearest ---- ,arr Field: Distance from nearest Distance from foundati ------- ------------Lengfh of each line--*'-.J '--/OA'Width of french_:?�n------------------------------ Number of lines Type of filter material------- Depth of-filfe"r mdi-erial J_9-------------Total length----_P' _______________________-- ---------**& Seepage Pit: Distance to nearest well----------------------Distance from foundation----:--------------Distance to nearest lot line_----.___------ El Number of pits----------------------Lining material--------------------...Size: Diameter_-.-----------------.Depth-------------------------------.. Cesspool: Distance from nearest weli-----------------Distance from foundation._.__._..-----------Lining material-------------------------- ---------------- ---------gals. El Size: Diameter--------------------------------------Depth--- --------------------------------- ---------------Liquid Capacity-. Privy: Di❑ Distance to nearest lot line----------------- -------------stance from nearest well.----------------------------- ---------------------_.--_._Distance from nearest bui�clinq------------ -------r------------------ --------------- ----------------------I----------- ---------------------- ------- ------:---- -- -------- -_-- 7 Remodeling and/or repairing (describe):--------- ----------- ------------------ --------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- ---- -------------------------------------------------------------------------------------------------------------------------------------------- ------- ---------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------r------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------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 aws, and rules and regulations of the San Joaquin Local Health District. ------------ ---fEkwiwand/or Contractor) (Signed)-------------- ---- --------- -- ----------------------- ------- ------------------ ------------------------ --- L_ ---------------------------------------------------------------------------)Title)----------------------------------- By:---------- --- (Plot plan, showing Size of lot, location of s tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPT� DEBY- --------------------------------------------- DATE- ?---_3A_7K7----------------------------- REVIEWED BN--------------------------- ------ DATE------------------------------------------------------------ - BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------- --------- DATE------------------------------------------------------------- Alterationsand/or recommendations:------------------ -------------------------------------------------------- ----------------------------------------------------------------------------------- -•-----•--------------------------------- ------------------------------------ ---------------------------------------------------------------- ----------------------------------------------------------------------------- ------------------------------------------------------------------------ ---- -----------------------------------I--------------------I------------------------------------------------------------------------------------- --------------_-----------:-------- ----------------------------------------------------------- -- ---------- ------------------------- - -------------------------------------------- -------------------------I ---- ---------------------- -- ----------------------- ---------------------- ----------------------- --------------- ------------------ ----------------------------------------------------------- ---- ------------------------- --- -------------- -----:---------------------- FINAL INSPECTION Date - -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.120.