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t-UKUrrlC,t USt: -------------------------------------- -------- ------------------------------------- / APPLICATION FOR SANITATION PERMIT Permit No. .. �.r ..�/.-,_ -------------------- -- ---------------- --------- (Complete in Duplicate) ----- This Permit Expires 1 Year From Date Issued bate 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. 544. OG-3 _ r �� IZq `t3 N - Nt&� 4� JOB ADDRESS AND LOCATION_,/ __, F_ -L____0,0C 111-s,��--*� f/�/-v��' i��,�� Owner's Name--- �� .t-/ '�r�---------- - -- ----- ----------- ---------- Phone--•---------------------•----------- Address---------71v---_"y0 '. o ? ----------- --- --------------------------------------------- Contractor's Name---------1 -!7A�5?e /------------------------------ ----------•---------- --- Phone......___-- Installation will serve: Residence Qg/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: _1°--_ Number of bedrooms _3 - NumhPr of ]-,a+kc -'Z Motel ❑Other -------------------------------------------- Numb r of living units:___- Number of bedrooms�______Garbage Grinder /fie Lot Size _- !' -=---------------•-•• 7.. .. .. Of ..r.,,, W„ ,r ,vc,. aa,iu 1J L7ravel L-i Janay Loam L__I .lay Loam 1J Uay LJ Adobe �Harclpan ❑ Previous Application Made: (If yes,date------__-- ) No �New Construction: Yes �No ❑ FHA/VA: Yes ©— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1. Septic Tank: Distance from nearest well...�?.19......Distance from foundation__/2_____.__ f"' [�'- No. of compartments__.e -___.._______---SizeX�^�.__ —Liquid depth, f ----------------Capacity ---._-. r ' W Disposal Field: Distance from nearest well...��._____Distance from foundation_��_______.Distance #o nearest lot line__��}�_- Number of lines--------a�__ Length of each line _�___--------Width of french-AZ.` 1 ----- �' Type of filter material��_ �--Depth of filter material___��_.__._.___Total length-_.x,Z-F_�_'fl__----------------------- Seepage ____________ _Seepage Pit: Distance to nearest well_--Z__A?f------Distance from found ation_1/ ___ 9____.Distanc� to nearest lot liie_�� `_' 2--, Number of Fts____ p --------------Lining material_�0` .--___Size: Diameter__ . .�• ---Depth '�, .0 "--------------- ---- Cesspool: Distance from nearest wall-----------------Distance from foundation------------_----_Lining material------------------------.-_______.__. ❑ Size, Diameter----- --------------------- ----------Depth------ ----------------------- --- - ---------------Liquid Capacity- ------------------------gals. Privy: Distance from nearest well-------_----- -------------------__----_..___.-Distance from nearest bui{ding.___ _______---______________..___. ❑ Distance to nearest lot line-- --- ------------- Remodeling and/or repairing (describe):--------. /jl ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------------------. ..4� 1 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. (Signed)------------------, � f' �`' r' �. 1 �..1 Pl�`1 -----------------------------( r Contractor) By: 41J (Title) �.1/1� .c._ -------- - - (Plot plan, showing size of lot, location of sus m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -! - DATE �j ��'j ------------------ IEWED BY ------------------------------------------------------------------------------ DATE BUILDINGPERMIT ISSUED.-------------------------------------------------------------–-------------------------------------- DATE Alterations and/or recommendations---------------___--------------------__-------------__•---__-_---_-_ - ------------------------------------------ ---------------------------------------------------------------------_---------- ------------------------------------------------ ---------------------------- - --------------------- ---------------- -----------------_-------------------- - - ----------------------------- ---------------------------- -•----------------------- -------------------- ------------------- -------- FINAL INSPECTION BY.., !y-- -------------- Date__. _ -+` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.CO.