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FOR OFFICE USE: --------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. - y: ----------------------------------- ------ .(Complete in Duplicate) Date Issued .---...--.-.:------------------- This Permit'.Expires 1 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. r This application is made in compliance with County Ordinance No. 549. x= 2bs^--�3�_p$' �1/�7`G19 r JOB ADDRESS AND LOCATI Ni DTT+F . --- - °FQ :- [-Y-- fir= THb Owner's Name--------- --`--- -----•- A �-- o' Arm-r)----'------------- ----------------'-------------------- -------- Phone----------------------------- Address-_----------------�� 1-R�=� ��' '--------- ��`�TG� ----------------------------_-------- Contractor's Name ....:.- - ----------- "` --------- Phone----------------------------------- Installation will serve: Residence Je- Apartment House ❑ Commercial ❑ Trailer: Court ❑ Motel ❑ Other ❑ Number of living units: --t).---- Number of bedroom-_-.- Number of Baths _= .__''Lot size ----, - -Q-- ------ ----------------- --.- Water Supply:7-Public system ❑_. Community system ❑ Private RT--Depth to Water Table ft. Character of soil to a depth of 3 feet: Sad Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ j Previous Application Made: (If yes,.date__. -.)-No U31 Ne-ii Construction: Yes K�o ❑ FHA/VA: Yes �Nci ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: °"= ,=...e _(No.sePt1c tank or cesspool,permittedn.if,,puubblic.sewer.is available.within_200 feet.)„„;,�. Septic . 4: Distance from nearest well 510.....Distance from foundation --R) .Material__<:0N!CReT� s -- Sizex1Qx ----L� e No. of compartments-.---- quid d� th---Distance�to nearest lot Iln� �-©' Disposal.Field: Distance from nearest well.-- ... Distance from foundation_--� -- �' T u eber filter material.,-_��- �'�..-Le gl of flitch line_-fQ0_'�-;1��Width of trench------e�.�--- ---=�--._--_-Len th of eac �- ------ •- Yp p material.---� �`.-:'`-Total length---------__p-------- s, i` Number of less-.-.._._-._.--__Lits' a -.Distance from foundation-----! .......Distance to nearest lot line----------------- e o . � p --------- -Wing material-=-----------------==Size: Diameter------ ------ --- Depth----------- Seepage Pit: Distance to nearest wei Cesspool.. Distance from nearest we ll_._ -- -___ --'bistance from foundation-_-_�_�___�-...---Lining material.-'----------------------- ❑ "Srze.: Diameter " Depth ---------------------•--,------- - - ------Liquid Capacity- -•----------------- ----gals. -Privy: Distance from nearest well ------------------------------------------Distance from nearest building........------.-.------------..--.-..--.-. ❑ ;:.. . ?, Distance to"nearest lot line------ - --- -=-'---- ----•----------- ------------=- - - ------- ---- ---- ------------------ -------------------------------- ---- Remodeling and/or repairing {describe}:--__-. .-_-.---: " ` ------------------------------------------------------------ •--- ---- -------------------------------------- --------- ---- ------ ----------- y: r, . ------------------------------------- --------------------- --------------------------------- ` ----- - ------------------------------------------------ - i ..----,� --------------k- --- I hereby certify that I haveeprepered this application and'that.the work will 6e done in accordance with San Joaquin County ordinance S 'laws d rules an'd r ulatio'ns of the San Joaquin Local Health District. s, q - I � ---- -----.:---- -- -----------------.-----:--------------------------------------------------- O (Signed)---- ------ ----- ----- -.- _ _ _ ( caner and/or Contractors usY - ----- --5-• - .- - ` ---------- ------- (Title] --- --- i -- ---- --- (Plot plan, showing size of lot, location of system in relation to wells, buildiiigs,'"etc�, ca`n be placed on'reverse"—side] FOR DEPARTMENT USE ONLY DATE ` .,. [ APPLICATION, ACCEPTED BY f. fl Q ---~ .•,'` ;. REVIEWEDBY---------------=----------------------------- ----- --------------------------------------------------------- ---------•- DATE_- -..."'. - ------------------------------- BUILDINGPERMIT ISSUED---------------------------------------7----------------------- ------ DATE----- ---------------------------------------------------- Alterations and/or recommendations: ------------------------------------------ - ---------------•-------------------------------------------- --------------------- •--- ------ --------- { ' ---=---•----•------ ------------------- -------------------- ------ --------------•------------------- --------------•--------------------------------------------- --- --- .- - FINAL INSPECTRDIA „ k Date '•77& ------ i y r, •. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street ;i Stockton,California Lodi,California Manteca, California Tracy,California r'.'a.c o.