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FO-R OFFICf SE7*A0r-1—' YCLY ---------------- - ------------------ -------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) Date issued ------------------------------- --- ------- This Permit Ex0ires I Year From Date Issued .._._______ ,�� Application is hereby made to.the-San Joaquin,,Local Heal+h District for a permit to construct.and,install the work herein described. This application is made in compliance with County Ordi r nance'No. 549, JOB ADDRESS AND LO ATIOP --=---•--------------------- ---------------------------------------------------- Owner s Name---------------- - ------- ------- -------------------------------------------- ------------------- Phone----------------------------------- Address------------- - - --- ------ ----------------------------------------------------------------------------------------------------------- A Contractor's Name-------------- .-------- ----�A--------- ------------------ -------------------------------------------- Phone........................... Installation will serve: Residence Apartment House E] Commercial [] Trailer Court E] Motel [] Other ❑ Number of living units: Number of bedroom-s.1Y.N-um / ' ber of baths Lot size -� -------------------------------------------------- Wafer Supply: Public system Community system M- Private E] Depth to Water Table Character of soil to a depth of 3 feet: Sand'E] Gravel E] Sandy Loam 0 Clay Loam E] Clay,E] Adobe[a-1 rardpan ❑ Previous Application-Made: 11f yes,date--------------------) No Construction: Yest Vj-1To El FHA/VA: Yes ®/No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted i-f,public.sewer.is availa6le within 200-feet.) N-1 T Distance from nearest well _—__Distance flone, M tep-a I T --iy Septic Ta --Jrorii founda ----6---------- M-1 No. of comparfmenfs----,.-_z---------------Size.tP 4!-,e!KV... Liquid cle�p.f�--- g�.-/---------Capdci� ----- Disposal F*efT Distance from nearest well----—----Distance from fo'undation.-/ -."----Distance to nearest lot line-- Number of lines-----,:2-1 engfh of each fine_----_- ------Width of trench...._... - - - -- - - - - - -1----Total lengfh---x'-�.Z?, Type of filter materia ---------Depth of filter maferial4X?�.1- 0 r St W is ance fr'Qm fo ------Distance to nearest lot line__Distance f nea e ell----- D' t :5� " --- ------------ Dw6afion....1-4-' 1 .0 Number of pits------It I-----------Lining rnaferial-,-'4�' -:;Gr ..Size: Diameter- -------Depfh---A, .-,J------------------- Cesspool: Distance from`nearest well'--L":----------:Distance'from foundation--------------------Lining material_-..----___----._._.-___---_-_---_-- �l ❑ aterial------------------------------------- El Size: Diameter--------I-----------------------------'Depth---------------- -------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest'well-------------------------------------------------Distance from nearest building_.--_--_--.___---__-._--____-----------.-. ❑ Distance uilding------------------------------------------ Distance to nearest lot'line----------------------------------------------------------------------- Remodeling and/or repairing [describe]:___:___. --------- --- ZZ------------ ---- ---A -4-V- - --------- --- -------- --------------------------------------------------------------I---------------------------------------------------------------------------------------------------------------------------------------------------------- : 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 Local Health District. 4. ---------:-------------- ..... -- -- -- --- ------ or Contractor) (Signed) ?- -------------------1CNMvra!n&_ ----- ----------------------------- By:------------------ ------ -------------------- -------------- ---------------- n !Ia�,O��W, (Plot plan, showing size of lot, location o system elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------------------------- DATE------- ----- ------ REVIEWEDBY------------------------------------------ -------------------- ----------------------------------------------------------- DATE--------------------- BUILDING PERMIT ISSUED---I—--------------------- ---------------------------------------------I---------- --------------- DATE--------------------------------------- f f - -- Alterations and/or e ommendafions:- ---------------------------------11------- I--------I-----------------------:-------- ------------- ----------------------------------------------- - ------------------I-------------------------- ---------- -------------- ......... --------- ------------------------------------ -------- - ------- .te --------- - ---------------- ---------------------- -------------- ---P --------------------- ----------- ---------- --------------------------- FINAL INSPECTION BY Date--- ------ -- -- - ------------------------- - ----- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Callformlo Tracy,California E6-9 REVISED 13.59 F.P.CO.2M &-SO R 4r1 Z-Z--7 e-e_ cow -7,