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_ FOR /yOFFICE USE: -- ---------'----____ D...a APPLICATION FOR SANITATION PERMIT Permit No. .................. ------- -- ------'--------------- ------------------- (Complete in Duplicate) ___.._._.__. This Permit Expires 1 Year From Date Issued 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. -#" JOB ADDRESS AND LOCATION--- 57------Vt--- - -' � - - - ......-'(- -------- ......................... - -- ------------------- � -------• --- - Owner's Name -------------- =- ' ' Phone__ Address-------- _?_—- ---1---- --'G--r-~ �-- ��L.C.�� ----------------- ------------------------------------------------------------------------------ ------- Contractor's Name------------------ - j'------------------- ---------- -----------------'- ---'-------------'-' ---- ---------------'----'-- - --'------ Phone-- ------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other IS Number of living units: -------- Number of bedrooms;______ Number of baths -------- Lot size __,��--�_ ,, .�-!------------------- Water Supply: Public.system t❑_. Community system [I Private P?�Depth to Water Table �f__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam El Clay E] Adobe �ardpan Previous Application Made: (If yes�date�!_--- --.--1 No ❑ New Construction: Yes ❑ No [�FHA/VA: Yes ❑ No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) iTapk: -Distance from nearest well---------'---------Distance from foundation--------------------Material------------------------------------------ .__._. b�k_4 No. of compartments- --------------------'--Size--------------- ------Liquid depth--------------------------Capacity----------------------- Ti64F ld: Distance from nearest'well-----------------Distance from foundation_________---_.----.Distance to nearest lot line______-_____-_� Number of lines------------ --------------------Length of each line------------------------------Width of french_._____.____,.__.-._ Type of filter material-__ ___________________Depth of filter material ...-_-_-_..___.___....Total length__.-_.__________________________--___..- See�pa,g/e Pit: Distance to nearest well-_/fj - ---.._-_D'sstance from foundation__- - ______.Distance to nearest lot linef1-5-: .- ld' Number of pits----2c_;�—-------\-Lining material --.-- - �___._____� _ ___ r - De th Cesspool: Distance from nearest well-_I:_.------------Distance Distance from foundation--------------------Lining material----____.__.__..___._______._________ ❑ Size: Diameter--- =----------I---------Depth----'------------------------ ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_.--.-. -------------------------:--------.......Distance from nearest building--------------------.-----___..___.._____ ❑ Y j. Distance to nearest lot line------'--= --'-------------------------r - ---------------------- --------------------------- ------------'-'-----------'- ----------- - ----'--- Remodeling and/or repairing (describe):_ --------------- ----------------------------------- ------------------------------------------------------------------------------------ ----------------------------------------------------- -----------------------7 -- � � --- -------------------------------------------------------- --•----------------------'------------------ --------------------------------------------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ; ordinances, tate I ws, and r es Pd regulations of the San Joaquin Local Health District. F � � � a Contras � (Signed)------------------ - -------------- - ------ ------ -----: ---- ----------- --- ------ ----------------------_----' ( caner nd/or tor) `''= ------------------------------ T �1.._ a .r.r-� ...... BY� �/ { itle) (Plot plan, showing size of lot, location o system in relatio o wells, buildings, etc., can be placed on reverse FOR DEPARTMENT USE ONLY C pp_ C APPLICATION ACCEPTED BY-- ----------------- -------------------------------------------- DATE------ _T_. '- --------------- ---- z REVIEWEDBY------------------------- '' ---------------------------------------------- DATE_._ BUILDING PERMIT ISSUED----------------- r ------- DATE-------------------------------------------------- --------- C �f - --- ----- ---- Alterations and/or recommendations:- -------------_---------y%�l-- =-----------•-••--------- -------------•-- --------------------------------- ------------------------------------------ --'--'---' ---------- ----------------------------------- -------------------- --------------------------------------- ---------- --------------------------------- --------------------- ---------------------------------------- ---------------------------------------------------- ------------------------------------ -- - --------------------------------- -------------------------------- -------- FINAL INSPECTION BY:.._____ ` ' _. jZ"------------------ Date. ' j.- 7----------------------------------- k SAN JOAQUIN LOCAL HEALTH DISTRICT ` 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.