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FOR OFFICE USE: 3 No. --. �` = ••t - ------- "" """ �J Permit -- APPLICATION FOR SANITATION PERMIT s --1L� --------- � ----- --------- Q' (Complete lete In Duplicate) Date Issued .. "U-- _______________ -- This Permit Exvires l 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. This application is made in compliance with County Ordinance No. 549. /. / �y �/FJ` .--•--•----------- -----------•--------••--•------ JOB ADDRESS AND L CATION__ _' l_.t ' = Ph ---------------------= -- ----- -- one Owner's Name---- -•---_-_--•--- q ------•--- •-------------------- -------- 1' Address------.._ �t�F-- -- -(� - --•----"-----------•----------------- � e --------------•-•-----•---- t - -�-----------------•--------------- on --- Contractor's Name---------- ' ' Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ ❑ e - 1 - ------------------------•- Number of living units: __ ." Number of bedrooms,.?-t�-- Number of baths _ .__ Lot size _ /' s t &p t. j. Water Supply: Public system ❑ Community system [Private ❑ Depth to Water Table y Character of soil to a depth of 3 feet: Sand ❑ Gravel F1Sandy Loam ❑ C3Clay Loam ❑ Clay ❑ Adobe ardpan Previous Application Made: {if yes,date"-------------------1 No '�`lew Construction: Yes []/filo E] T HA/VA: Yes W.,- No E] TYPE OF INSTALLATION AND SPECIFICATIONS; ! (No septic tank•or cesspool permitted ifublic sewer is available within 200 feet.) i p Material. --------------------- Sepfic Tank: Distance from nearest well __." ---Dis#an�e-••f,rom foundation-- id de th-__ �--;'----:-Capacity___¢.�� =---- No. of comparfinenfis----- ----------------Size_s ' -- :- g p' `�-�_:---Diitance to nearesi�ot line._��----- 3 Disposal F Id: Distance fromti}Weare t ell TDistance from foundation_.____ f /� - Width of trench.__ _---"-- !�' ---- Number of lines___________________ Length of each line.___ Z Type of filter material_ Depth of filter material___- ---�--Total length'{ 5 ��-f r /`9_ Distance to,nearest lot line-- ----.- {--C -- ---- �--� i i f Seepage Pit: Distance to nearest well - "-------Distance from fou dation_." r �f � p --- ___.--Linin material___ Size: Diameter--�Z - Dep#n_..---- ----- 1� ®/�I Number of its-----_� - g - i i Cesspool: Distance fiom nearest wel!_________________Distance from foundation._-._______.__.__.Lining ma#enal------------------------------ -------- _.- _-. els. ' Depth -----Liquid Capacity-- 3 9 Size: Diameter----------------------------- ----- p - , ;,,❑ Distance from.nearest building- -------------------------- Privy: Distance from nearest well ? _ ------ --------------- -------- Distance to nearest lot I ne------------------------------------------ 'L ----------- ---------------•---------•--- -- _ ---." Remodeling'and/or repairing.(describe}:___"-.-.-. --- I -----------------------------•--------------------------•----•------ ----- .0 4 I I..hereby certify'thaf I have.prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regulations of the San Joaquin Local Health District. r € Contractor) --- ---------- --- r C or (Signed). P� �J ----------------- ----------- By: :. { - J -• ---------[Title)--- �_' -.� - �` .. By:----------------------•------=-------- ---------•------------------ - ,,��,_ . (Plot plan, showing size of lot, location of system anon to wells;buildings, e'tc.; can be pplaced on reverse side). FOR DEPARTMENT USE ONLY / �//--- I Y ACCEPTED BY ------- �}'1-- DATE tt -- -----�- ----` n APPLICATION. DATE-----------------------•------------ REV�IEWED B ------------------------- ----------------- -------- --------------------- ------ - -------- - ---- -, --------------------- Alterations ----=--• ---------------------------=--------- ---=-------"- DATE-------- --------------- - ----=---- ------------------ -- BUILDING PERMIT ISSUED-----•-------------------------� �.,� =` fes` ` 1 Alterations and/or recommendations:__._..�sr � - _---------• _------ i ----------------•------- -' ----- --------- -------- ------ - --------------------- - -------•------------- ------ -----=-------------------- ______________________________________________________"_._.__.-_._. - ----_--____.------"-----_----- __...._.__-._..__.._ F - " ---------- Date----'-��---� � ----�-----'------------------------------- t FII.NAL INSPECTION BY:----- 3.----•-- -- --- -------- •------ a AN JOAQUIN LOCAL HEALTH ISTR C1 l 300 West Oak Street 124 Sycamore Street 205 West 91h Street 1601 E.Hazelton Ave. Tracy,California Stockton,California Lodi,California Manteca,California ES B REVLSEG L3-59 3M 3-'6'3 rr "