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F R OFFICE USE: ------ ----------- C 6 1! Permit No. �. - Iu._. f' APPLICATION FOR SANITATION PERMIT ` 0i (Complete in Duplicate) / t19 --------------------A; --: Date Issued : _g'' "" :'"-_ This Permit Expires 1 Year From Date Issued Application-is hereby made #o the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliarice with County Ordinance No. 549. c�yj� rf' R !<r"----------------------------------------- -------------- ---- JOB ADDRESS AND CA ION-----�y-7------ldi�------- ----- -------- ---------------------------- � ' Phone. _raj_ Owners Name----- ---------------- Address----------------------- - `----- ---- ' ----------_ �I -----..--------------------- Contractor's Name r ------ Phone---------------------------------- i Installation will serve: ^,Residence Apartment,HouseYOv-CommercialTM❑{ Trailer Court Ll Motel ❑ Other ❑ .» Number of baths --- /___ Lot size ._--__-- L`r--'---------- i Number ofAving units: ____=_":Number of bedroom { "�� '•""�"-2 Water Supply: Public system Community system ❑ l Private ❑ Depth fo Water Table - ft. Character of soil to a de Wof 3 feet: Sand ❑ Gravel 0Sandy Loam El Clay Loam ❑ Clay F] dobe Hardpan ❑ C P .i ,, , ?. Previous Application Made: '(I#yes date-------------- No':❑ New Construction: Yes EO] No HA/VA: Yes ❑ o ISA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank or cesspool permitted-if public sewer is available within 200 feet.) S c : Distance from nearest well-----------------Distance from foundation__________---------.Material-------------------------------------------------- e� yN .......... .. -— - -.--.--- Liquid'de th`---------- -----Capacity No. of comparfimentsi = Siz# ------ P. ... �y /_-.Distance from foundation__ _. ___-- Distance to nearest lot li ^_--... �c'alield- Distance from near t wel€__ _. �� °Len th of each,line :_ "� � ,----Width of trench--- ___ - ------- Number'of lines_____ - .-"-.- 94 !' _.De th of filter matkial:-�R. f Total' ---------__ ... Type of;,filter materia " 1 .� Sa e Pit: Distance to nearest well__ "-"----------Distance from fo undation___.f""p_*___. st nc+ tonearest lot line_______________. _ Linin material_i _ Sizer Diameter__.." -----7Gbepfh------a' _---------.- Number of pits------ ----- -=�- ` ;.4 I # t Distance from nearest well from foundation-- mafi�Ia-------------------------------------- Cesspool: r ` ' ❑ Size: Diameter----------------- i------ ---------Depth----------------- ----- ------------ i Liquid Capacity gals: tDistance from nearest buildin Privy: Distance from nearest wel--------------------------------------------------- 9-------- ------------ ----------- ❑ —.;. f -- Distance to nearest lot;line.j.._---"-.-_-"--.1 ---------- f y - v ii Remodeling and/or repairing (describe :----II---- ------ ------------ --------- ---------i----------------------••------ --------- ---------------------- ----------- --------------------- ___"--____i________ _ _ _ _. _�__ __ t ,i --------------"--•------____-_.___....__--- ----_. . __ _ _ ____________ I hereby certify that I'have prepared this application cind that the work wit be done,in accordance with.San Joaquin County ordinances, tate s, and r s and regulations the San Joa uin Local He th District. t ; U Al --- 7r1Afnd�or Contractar) ------ -.r- ---------------------- if (T --------------------- By:------------------------------------ e) •s (Plot plan, showing size of lot, location.of system in ref on.to wells, buildings, tc., can be plat ,never` side). ) �.. FOR DEPARTMENT USE ONLY '^'��-------------------------------- E---- ` APPLICATION.ACCEPTED BY------- ------ - ' REVII WED BY �� -------------'------- D ' --------- BUILDING; PERMIT ISSUED----------------------------------- �-:-------------------------.------------------ DA Alterations and/or recommendations----------- ----------------- ------'_------- --------------------------------------------- -----•--------------•--------•--------- ------- i! -------------------------------••---------- t ----- ----------------- r-------- ----------------- ----------- ----- ---- -- i: ,. :1 _ . & _....-.__"_____________ _______"__--_-.-.__----__.__ ...._"--___._ "--_._._ __-- i � fi S FINAL INSPECTION BY i_ {date-...__f .----- ,k SAN JOAQUIN LOCAL HEALTH DISTRICT 4 1801 S.Hazelton Aw. 300-West Oak Street I; 124 Sycamore Street 205 west 9th Street F Lodi,California Manteca;California Tracy,California Stockton,California l' E6 9 R6VIPEO 8-59 3M 3-'63 F.P.CC. ,,