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J FOR OFFICE USE: p� ------------ -------- --- Permit No. - - - APPLICATION FOR SANITATION PERM! f----- ---- (Comple+e•in Duplicate) Issued S - ---------- ----- Date ....... This Permit. Expires 1 Year From Date Issue 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. -----•--------•-- JOB ADDRESS AND LOCATION---i90A ---- - Phone._- .... - --------Owner s Name___ -- --- Address-----------•--� -----_/ - f- n ------------------------------ D k -- - �/j/ Contractor's Name----------------------- ------- Phone._y-Yi__ ----- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Mob l ❑ 94 A410" Other 701,j E i Number of living units: _- -" Number of bedrooms -------- Number of baths-------- Lot size ----- --- --------- - - Water Supply: Public system❑ Community system Fl—;Private—),—Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay C] Adobe), Hardpan [I t� Previous Application Made: (If yes,date.--------_"----- ) No New Construct-son: Yes No ❑ FHA/VA: Yes ❑ No-% I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer'is'�•available within 200 feet.) ` t Septic_ Tank: Distance from nearest well-./00 Distance from foundation__- d__._"_.."Materiai.._-4-o ^��----------------- " _ ---- --------- Liquid depth- - ----- ----.. ---------Capacity---------------------- nt i Dial Field: Distance frromrnear nearest well".M-`--Distance from foundation__ s "�-------Distance to nearest lot line ___----__"_____ f p Number of lines__ -- - Length of each line__.___-"--4"�--�r--------Width of trench_."._-� __�._.---------""-"-- Type of filter maferial- - " Depth of filter material-_./ '.".".'__"_Total lengfih_--_ _�--------------------- [ to f Seepage Pit: Distance to nearest well.jo---------Distance f om foundation_-_e�---------Dista e to nearest lot line_-------------- ti F Size: Diameter----33_-�- --Depth---1�' ---------------- Number of of pits.". ._/�-.,,_ --_.._Lining material__ _.. . _. __ -,_. Ces�ool: Distance from nearest-well --"___--"-_--._.Distance from foundation-.-. Lining material________________ ____.____:____"__ ❑ Size: DiameterY "'f= a =,Depth--------------- --------------- - -----Liquid Capacity 'gal i }Distance from nearest building_____--___,".__---------------"----._. Privy: Distance from nearest-wel-------------------------- ❑ Distance to nearest lot-line—____ �� Remodeling and/or repairing {describe}--------- ---------k -------------------------------------------•---------------------------- ------------------ ------ ('6b --------- --------------- •- ----------- f - . ---- ----- --- _ I - ---- hereby certify that I have prepared this application.and that the work will be done in accordance with San Joaquin ounty ordinances, State ws, and rules and regulations of the San Joaquin Local Health District. r �nil�r�C (Signed)--------------- ------- wner and/or Contractor) - �---- •'=- -- --- - -- - � --- - -r- ----------- - - -- ---------- - -- ------ -- - ----- -------- Title � ---`-- ------- --- ��------- ------ I ' "__ 8Y= c--- - - ( ) - (Plot plan, showing size of lot, location o s tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE'ONLY " _ DATE--.--T---- ---- - ----------------- - -�- - --' -- ----- --- APPLICATION ACCEPTED BY-___��--�--- - -�--� �----------- - -- -- REVIEWEDBY-----------------------=------------------- - ------- ----------- ------,--_- ------------------- ------a--------- ------ DATE-- ------------------------------------------------------- - BUILDING PERMIT ISSUED-------- "------ - DATE --------- ------------ -- Alterations and/or recommendations:----------------- ----- --- --------------------------------- ----------- ------ ---- ------------------ .. •---- -- i ____r -----------.--------------------___________ _"__._ ----- F r__ _______________________ --.".-____"Y___--------__Y- } - - Date- --------------- ---------- ----- FINAL INSPECTION B - �� - SAN JOAQUIN-LOCAL HEALTH,DISTRICT 1601 E.Hazelton Ave. Soo West Oak Street.. Y 124 Sycamore Street 205 West 9th Street a.Manteca,California Tracy,California Stockton,California lodi,rCa'lifornia " > E.H.9 2M 1-67 Vanguard Press