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��p OFFfCE USE: Permit. No. .1--e�-----1-�'-�'-•" --"--- APPLICATION FOR SANITATION PERMIT � _.� b is -- - - --- -- ------------ (Complete in Duplicatel Date-issued ----- ---- -------- This Pirmit'Ex ires 1 Year From Date Issued A �-�-", r permit to construct and install the work herein described. A lication is hereby made to the San Joaquin---------- ------------------------- ------------- " _- � uin Local.Health District for p A papplication is made in eompl-+ante with County Ordinance No. 549. lr� r` -` --- -•----- Phone .... CATION. _?yam - -------- JOB ADDRESS AND LO -- - ------- Owner's Name....__-- - ---•-- '+'[ Address------------ - -1a-----------�' . . # _ = Phone...._ --- ----------------------------- Other 0 -• ----------•---•---•,.--�---------------------- - - --- r - Trailer Court ❑ Motel ❑ Contractor's Name---��!' "T � Commercial ❑. � �••� Apartment House ❑, j" c?_ ?.1----------- Ill will serve: Residence p Number of baths Lot size .... - r Number of living units: -_j._... Number of bedrooms -- -„ r 0 De thio Water Table .S�ft. "' Community System ❑ Private P Adobe Hardpan ❑ Sand Loam ❑ Clay Loam ❑ Clay ❑ Water Supply. Public system ❑ �. Gravel ❑ Y VA; Yes ❑ No ❑ New Construction: Yes J[ -No ❑ FHA/ VA: of soil to a depth of 3 feet: a Sand Application Made: llf yes,date--------------------a No,�' Previous App ''t J TYPE OF INSTALLATION AND SPECIFICATIONS:,. , -Y�- ' tic tank or cesspool permitted if public sewer is available within 200 feet.) (No septic -i • foundation--,/J Material---------- ------------- r, k Dista ce from --O Capacity." ---------•-•-- f septic Tank: Distance from nearest well.. --- �, ,_�--------Liquid depth.....� Size..=J. O `orn fou _�_-_...Distance to nearest Lot line-- ......... No of compartments-.--- N ----- i i F Width of trench-"- ' i Disposal Field: Distance from nearesf well_..:` Dength ofreach lsne 1ndafi0�-------------` Number of lines....__-- Total length...... ------------------•--•---- ." Depth of filter matenal.w� ----- -; Type of filter materi� ' �� •--=•-...Distance to nearest lot line... Size: Diameter.-----------•-------- Dep th--------------------------------- Distance --- ------------ Seepage Pit: Dis#once to nearest well--------- from oun a tion---------- Number of pits--------------------- Lining material----;-==- D+stance from nearest well----------------Distance from foundation.---- Liquid Capacity_- --=-- - gals. cesspool: .De Depth --,------ ---- ------•--•-------- ---- - - -- -----•-------�------------ Size: Diameter------------------------------ p m --------- Distance from nearest building"- i Distance from nearest well--------------------=------; ------ --• ---------- Privy:, n -- - -----:--- ~ -- ------ ❑ Distance to nearest lot'line.- ----- , i.. ... �' ?..._....-.".."............................................."..._........._._.._. ". ........................... Remodeling and/or repairing (descnUe): }----------------- i - ------------------------------ -------- -;------------------------------------------------ ------------ - - - - - ----c------ Gcation and that the work will be done to accordance with San Joaquin County ------------------------- this'app I hereby certify that I have prepared ordinances, State laws, and rules and regulations of the{San;Joaquin Local Health District. to and/or Contractor( r ..... .._.. _.-..".. _ .. ... ---------------------------�-----..--._..._.. - . _ _.........."_._.._."_ s (Signed)--------- - •--� --- _ {G •. (Title)*_ ---"on reverse std ----- - -- -•-- --------------- n ;�t ;�----= e. �. 'By--- --------=--------: Plot plan, showing size of lot, lota>`iori of system-in relation to wells, buildings, etc:, can be placed x ( s-, t ; FOR DEPARTMENT USE ONLY ` ------------------- DATE----- `.7--` --•- ---------------------------- APPLICATION ACCEPTED BY: -- -- - --- - ----- DATE------------------------------------------------------------ REVIEWED BY------------------------------------------ ---------------------- -- DATE...-----------•----------------------------- ------------------------------ BUILDING PERMIT ISSUED._. -------------------------------------------------- Alterations and/or recommend'tions:.-- -------: --------- =' ---------------- Datep...... --------------------- -------- FINAL INSPECTION - SAN JOAQUIN LOCAL HEALTH DISTRACT 205 west 9th Street 144 Sycamore Street 300 West oak Street Tracy,California 130 South American Street Lodi,Californla Manteca,California Stockton,Californla E8-9 FIEVI68D 8.59 F.P.CO,2M 6-6G