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FOR OFFICE USE: ----------------- -------------------------------------- ----- ------------ --------------------- - -------------- APPLICATION FOR SANITRTION PERMIT Permit No. 2 .....,.................. ------------ --------------z.,_------------------------- (Com 4 plate in Duplicate) .1 "i Y�ear From Date Issued Date Issued ----------- -- --------------------------- ------ s Permit Expires I Application 'is hereby Anade to the San,Jodquin' 'Local Health D_isf6c`t for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance'N 0 _`1 I - JOB ADDRESS AND LOCATION —------- - -- ----- ------?, Owner's Name.----_----_-___- ---- ...... .. ----/--------- ----4el - - -------------------- ----------- ---------- Phone.,---------------------------------- Address-------------------_---------- -- -- ---I-- --------- --- ------------------ Contractor's Name------------------ . ..... --------f--------------- -------------------------------------- Phone---------------!---------_-- ------ Installation will serve:. Residence E&-1Xp_artmenf House E] Commercial E] Trailer Court El otew El Other E] at size ----------------�a------ 6 Number of living units: -- --- Number of bedroom5 j--- Number of baths Water Supply: Public system Ej Community system I] Private Ei--f7�epth to Water Table 67ft, Character of soil to a depth of 3 feet: Sand [] GravIl 0, -Sandy Loam E] Clay Loam E] Clay E] Adobe Ae Hardpan_E] Previous Application Made: (If yes,date--------------------) No ew:Construction: Yes Ujetlo E] FHA/VA.- Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availabie(within 200 feet.) ' Septic Ta Distance from nearest well----- i if a nce from found ----------Malarial----- -0-h /------------ No. of compartments----- _- --------------- Size----— ----- -------------Liquid depth -Ca... pacity__ -------- -------- Disposal F* Id: Distance from nearest well____-0 lDisfance from founclafign-_ Distance to nearest lot line-j-P5----------- QL1_ _ ."___3 ength of each line_-__ --- ---):f7 .Widfh of trench--..p-- Type of lines,---------- Type of Cfer niaterial-_-A _741 epfh of filter material___-.----- - __9�--------Tota! lengfh___,005p------------------------v --- Seepage-KI: Distance to nearest well---XV...........Distan-ce �u�ize: ation-_16-------DistanieNumber of pits Lining me Diarneler___lfe_Fisl:� p ,to nearest lot line----- Cesspool: Distance from nearest well-----------------------Distance from f6undafion... ----------------Lining material_--_---._--__._---._---------------. ❑ Size: aterial---------- --------------------------- Size: Diameter---------------------------------------Depfk_��_ 1 ------------------------Liquid Capacity----------------------------gals. I . j, I------------------ Privy: Disfance.from nearest well---------------------_--_-_--_---_----_: ! ----Z__'_bisfance from nearest building__------------------- �=*.: � -' ❑ x Distance uilding------------------------ElDistance to nearest ]of line---------------------------- - ---------------- 3 ------------------------- Remodeling and/or repairing (describe}______________ -_ ---_ - j_ -------------- I------------------------------------------------------I----------------------------- ----------------------- ------------------------------------------- --------------------------------m-------------------------------------------- ----------------------------------------------------- ------------ ....... =V7= --- -- ---------------------------------------- j --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- ---------- I hereby certify that I have prepared this application and th6f,fhe work will be done in iiccordance with San Joaquin County ordinances. State lay&,-aqd rules and ru�� i ns of the San Joaquin Local Health-District. f --- -------- - By:--•----------------------------------------- i Ilk �- ----- --------- (Plot plan, showing size of lot, Iota;-r in gs,.jet ri_�i_place <�;e on revers(Signed]------------ ---------- (Owner and/or Contractor) o o _,f,,s;e i�nl ---b u id e side). -,e t prijoy(pi c�. can FOR DEPARTMENT USE ONLY - --------------- APPLICATION ACCEPTED B --- -- ----------------------- --------------- ----------------------------------------- DATE----- x------ REVIEWEDBY--------------------------------------------- ----- --------------------------------------------------------------------------------------------------------------------- DATE------ ---------------- BUILDING PERMIT ISSUED---------------- ---------- -- --------------------------- ;------------------------------- ------------- DATE---------:---------------------------------- Alterations and/or recommendations---------------------- ------------------------ ----------------------------------------------------I-------------- ---------------------------------------------------------------------I----------------------------------------------------------------------------- -----------------------------------------I---------------------- ----------------------- -------------------------------------------------------------------------------I----------------------------------------------- -------------------------------------------------- ------------------------------------------------------------------ ----------------------------11--------------------- -------------------- -------------------------------- ---------------- -------------------------- - ---------------------- ------------------------------------------------------------------ ---------------------------------------------- -------------------- ----- � FINAL INSPECTION B _ 5 --- -------- Y V4. Date- ----------- -� \SAN JOAQUIN LOCAL HEALTH:DISTA ICT 7 1601 E.Hazelton Ave. 300 West CIA Street I 2\4'S ore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVOSED 9-59 3M 3`63 F.F.00.