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<FOR OFFICE USE: -� /,QU l/ "r -- ----- -- 171 --------------------- ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit o. �� (Complete in Duplicate} --------------------�.------ --- -,�:.----- ----- Date Issued ----= This Permit Expires 1 Year From Date Issued ' Application is hereby made to the San Joaquin Local Health Dist rid for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance.No. 549, A -- JOB ADDRESS pAN�DnJ CATION: --"Y"c.. C �-.Y[.Fx_ (3 Owner's Nam W7Lt "APhone. = --- �''' Address----- u� = -------•------------•------------------------ ----- } _ ------- --- G -------- Contractor's Name Phone ------------------- ---- ------ r Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E Number of living units: _ Number of bedrooms __ tuber of baths rooms ____..-_ Lot size _=_;_G - •-- Water Supply: Public system ❑ ':Community system ❑ Private'[ XDepth to Wafer Table _______ ft. 'A _ Z Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam'❑ Clay Loam ❑ ' Clay ❑ Adobe ❑ Hardpan 1 Previous Application Made: (If yes,date..------------------] No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: F �S g (No septic tank or cesspool:.permitted if public sewer is available within 200 feet.)_:, - - P ' Se tic Tank: Distance from I nearest well-----------------Distance/from foundation----_---------------Material _____..:____..-------------__------------- .____. ❑ No. of compartments--- -- --------- Size.__..---------------- -------Liquid depth--------------------- ----Capacity------------ --------- a r ! — + -- S t weltB'__._._ Distance from foundation____/- _____.___.Distance to nearest lot lin ___* ________. Dispos geld: Distance ofoline's eares ------------------------Length of each line---_- ---------------..Width of trench_----- ,._.-.---------------- Type of filter maferial__t-.___ Depth of filter material------- ____Total length------__—s�0--- ----------______.___ .-.rte- ; { 5eepa Pit: Distance to nearest well._i_ _(J_C�_---___Distance from fo ndation_-__I_ ________..Qistfnceto nearest lot.line--.5._____. Number of its------ Lin.ing material__,1t.,07r.Size: Diameter---------- Dept h---- -�____-------------- Cesspool: Distance from nearest well_ _--___ .-.__Distance from foundation---_-------- --------------- _______ ___.Lining material-_-------------------------_____.__. . . : Depth r -----. _Liquid Capacity. ❑ Size: Diameter.__--------------------- Ca acit Privyt Distance from,nearest well ______.---------------___t---------------------Distance from nearest building---------------_-------------------------- `� ❑ rDistance to nearest.lot line`..._---------- '" Remodeling and/or repairing e� ibe�- -—------------ ------------ --------------------- ________________________________________ __._'_ __________________-________-_-___.__.____ _____ ___ _ .. Ak" z _e4,�c�Y,d ------------------------------ : -------- ----------- --------------------------------- - -------------- t_- ..C�----e------ ---I----------------------------------------------------------------------- -------------------•-----.._._. I I hereby certify'that Vhav Qrepared this application and that the work will be done in accordance with San Joaquin County } ordinances, S laws,'and rules ; nd regulation of the San Joa in Local Health District. . ' �" -- (Owner and/or Contractor) (Signed)-------------- -- ------------------ --_-r--l--- -- -------------- ------------ _ "i' - = - `.= _ =_(•Title} By% ---- •--------- •------------ y ----- -- -- - -- - �' (Plot plan, showing size of lot, location of s s m in rela ion to wells, buildings,,etc., can be placed on reverse side). Y. FOR DEPARTMENT'USE ONLY oe APPLICATION ACCEPTED BY___ ,7 I DATE REVIEWED BY--------------------- "-- ----------------- ------- ------------------- -------- --------- ----- DATE----------------- ------- --------------------------- li I BUILDING PERMIT ISSUED---------- - - ------ ------ ------------------------------•-------------------------- DATE.-------------------------------- ----- - --------------- �I Alterationsand/or recommendations:-------------- --------------------- - ------=-- •------------------ ----------------•---:---------=------------------------------------------------- r, ------------------------------------------..._. •----------------------------------- ------------------:----- --�-----fir- --------------------- --------------- • ---•- w -- ---`-- -- ------ 1 I .",.- ----- la ` ------ -------- - ----- `= =---------------- ---- ----------- -- '--•------+�- - s k r. 1 FfNAL INSPECTION B --- --------------------- Qate__._ .' 6 .r SAN JOAQUIN LOCAL HEALTH DISTRICT ` 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California 'I Lodi,California Manteca,California Tracy,California ES 9 REVIHED B-59 3M 3-'63 F-F-CG-