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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - - --- -------f ------f3.`7 (Complete in Duplicn#e) f G -------------- This This Permit Expires 1 Year From Date Issued Date Issued ----______l_____, �- Applica�ion 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 Ordinanc o. 549. JOB ADDRESS AND OC ION __`- -- --_— Owner's Name----------- . .n ��.5' /lS t= Phone ------ 9 Address--------------------------- - , y ------------- ------------2---------•----- ----------- Contractor's Name_______________ _______ ---------------------------------------- ----------- 'Phone -- '� ` Z -- ----------------- - = Phone. Installation will serve: Residence [Apartment House❑ Commercial (] Trailer Court ❑ Motel ❑ Otheri 00 ❑ Number of living units: ___ Number of bedrooms -+.< Number of baths _<, _ Lot�size _-ARAO_O.- --.- Water Supply: Public system !Community system ❑ Private,❑ Depth to Water Table _ ft. y r Character,of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] AdobeOI4 Hardpan ❑ Previous Application Made: (If yes,date-----------,--------) No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -9 .y (No septic tank or cesspool permitted if, blliic�s�ewer�is available within 204 feet.) /fes Seek ptic T nk: Distance from nearest welll.."'.'!`�'__Distan e from foundation_-f4----_--.Material /"""------------------------------- v No, of compartments__----._1p�__-.--.-Size'��LX-K_?_Liquid depth.... _.__..._ Capacity-- -©!'!j { Ca acit � Dis osal Field: anearest wel Distance from foundation--/'Q__ -----.Distance to nearest lot Number of Ines - Length of each of french-------7 4 � lin_e_-___._.-__..:- :Type of filter material ��_-�iGl _ D ---.__-._-- I i SecpagL-flit: Distance to nearest��ell.�34A'.___Distance from foundation---.3--S'."._--.Distance to nearest lot li e_-,$-----_-_-_ � Number of pits-------------------_.Lining material- .........Size: Diameter- �. ._Depth_ --------------.---.-- G sspool: &-4r Distance from nearest well---------------- Distance4rom-foundation--------- _Lining material_____c_:_---_-_-_.---_---------------(10-1 " Size: Diameter----- -------- -- -------- -- '.De th----------=-----------------------------------------Li uid Ca acit F O Privy: Distance from nearest,s IL_.._____� _ -`-_------_---------------------Distance from nearest building + �" g----:--------- ❑ Distance to nearest lot'.line----------------------- � � ------------------------------------------------------- Remodeling and/or repairing {deseribe):---------------------------------------------------------------------------------------------- 'ter At Ai-TI - -- --------- --------------------------------------------------t=-----------------------------=---------------------------------------------------- ------------ ------------------------------------------------------------ ---------------------------------------------------------------------------------------`------------------------------------------------------------------------ •---------------------------- ----------------------------- t I hereby ter ' y that I have prepared this application and that the work will be done'in accordance with San Joaquin County_'� ordinances, St aws, no rules a' d re lations of the Sa JoaquirkLocal Health District. {Signed - - -- ------- (Owner and/or Contractor) i ' - Title.- _ .-_ (Plot plan, showing size of lot, ocafion of,stin to n ystem elaowells, buildings, etc., cabe placed n reverse side). FOR DEPARTMENT USE ONLY k / 1 APPLICATION ACCEPTED BY....._' . ..:...: �- -------------- ------------------------- -•- - - -- ------ DATE----- REVIEWEDBY----------------------- !---------=----------- '------------------- ------- ---------- -------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED - f :: - DATE----------------------------------------------------••----- Alterations and/or recommendations:--- -- l._. __.---- -,moi : �6-�--:--------C-.2------------ ---- ---•-�''`�<--•--eflL��-r�rr..."sa�------- fL''-��'€ ----- ��"r..-- --�<s-t-------- '_•-�C��t-..ate------- -•--------=------- --. � - FINAL INSPECTION BY:- - ------- Date...... ------ --- SAN JOAQUIN LOCAL HEALTH DISTRICT ¢ a 1601 E.Maselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.