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FOR OFFICE USE: ----------------------------------------------- No. APPLICATION FOR SANITATION PERMIT Permit ...... ------------------------------------------ ------------ -------------------------------------------—------ -- (Complete in Duplicate) Date Issued ------------------ This Permit Expires 1 Year From Date Issued L " 6P Application is hereby made to the San Joaquin Local Health District for a permit to con 9ctTistall the work herein de's'cribed. This application is made in compliance with County Ordinance No. 549. 91OwnJOB ADDRESS ANQ,)_OCATION_4�- --I ----- -------9----- Owner's er's Name--------- ------ -------- ------------------------- -------------- -------------------------------------------- Phone-=---------------------------------J, - -- ----------------------------------------------------- ----------- Address------- . .......a!p/------ ----------- ----- --- Phone--------•-------•--------•- N Name- .. .... ------- IN A Installation will serve: 'Residence Apartment House E] Commercial El Trailer Court E] Motel 0 Other El Number of living units: 4--- Number of bedrooms _ Number Lot size ..----------- ------------------- - / ber of Water Supply: Public�msystern El Community system ElPrivate Depth to Wafer Table _70 E] ft. � Character of soil to a depth of 3 feet: Sand Gravel 171 - Sandy Loam E] Clay Loam ❑ Clay Adobe 0 Hardpan a ! J Previous Application Made: (If.yes,date--------------------) No F1 New Construction: Yes -El N o [:1 FHA/VA; Yes ❑ No E] �klj TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) epti;r T k- Distance from nearest well-________________Dista-rice from foundation______.______.---7--.Maferial--------------- --------------------------------- No. of compartments-----------------------.__Size--------------------------------Liquid depth-- ---------------------Capacity.-------------------"-- --- -Distance from I nearest well__,05,4P__`_Distance-from, founclafion--la!--- Distance to nearest-lot line------ F3 ie : - Dispos Number of lines___.-----_- Z Length of each ---�Wiclfk of french.____,'-7---------------------- Type of filter material_�W,-_-, Depth of_filter material_-_-- r-----Total length________ AOQ..___________________ est lot line-.,;�_/--- See it: Distance to nearest well_-_119/P-------Distam Distance to near ------ & 'nefer- . ____.De pth_,02j___/__.----------- 1) _..Size: Diameter__.Lining materia Number of pits___..__-."""."" from foundation___v.-.,__._____..Lining material___:___..__.__________:___.____._____. Cesspool: Distance from nearest well-----------------Distance .111. f. i o - ----------Liquid Capacity------------------ ---------gals. ❑ Size: Diameter-7--------------------------------------Depth----------------------------- -- ---M�... 3 Privy: Distance from.nea re;+'well__---------------------------------------------Distance from nearest building._____-_____.________________________-__. F1 Distance to nearest"lot line-__,xA_ ------------ ------- --------------- -------- ------------------------------------------ ------------------------- V � � - 1� . ---I-------------------------------------------------------- Remodeling and/or repairing (describe)-----------------1:�---------------- `'=-r.;;_-------------------------------------------- --------------------------:---- ------ ------------- --- ------------------I--------------------------------------------------: -----------"--------------------------7--—�--------------------------------------------------- _----•------------------- ---------------- ------------------------------- -------------------------------- -------•-----------------"---.-------------------------------------------••----- -----------!�, ------------------------------------- -------------------=--------------------------------------- ---------k i_Zf---------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law,wjand rules and regulations of the San Joaquin Local Health District. - - - -------------------------------------- -------- .:------------ --------(Owner and/or Contractor) (Signed)--------------- -- -----=------- By:------------ ----- ---- -- ---- - ----- --- - ------------ ----- -------------- (Plot plan, showing size of lot, location of system in r ion to w Ils, buildings, etc., can,6e placed on reverse side). FOR DEPARTMENT USE-ONLY—,----L�,� -----------------------------------------j'*.!.-�CiATE--.-.-.��---..--/--�!---4k-l�/---------------------- APPLICATION ACCEPTED ,10Y---- - --- - ------- -- --------------------- ----------------------__:_:..DATE:----------------------------------------------------------- REVIEWED BY-------------------------------- -- ------------------------ ---- ------ -Il_ j kJ _7 DATE.�_.---------------------------------------------- --------- BUILDING PERMIT-ISSUED----------------------------------------------------------------- ------------ .41_�,_ Alterations and/or recommendations ------- ---------------------------- --------------------- ------ -------7------------------------------------------------------- ----------------_ ------------------ ----------------------------------------------------- --------- --------------------------------------- ------ -;------------------I------------------------------------------------------------------- ------------- ------------------------------------------------------------------- - ---------- ----------------------------------------------------- ----------------------------------------------------- -------------------------------------- ------------------------------------------------------------ ---- ------ -------------•------------------------------------ -- -.-- - -------------------- ------------------------------ -----------------I--------- ----------- ----------- ---•-----•------- ----- ---------------- --------- --------------- -----------------•--_---------- _,_. ----------- -- FINAL ------------------- INSPECTION Date. ..... SAN JOAQ U IN-LOCACHEALTH-'DISTRICT 1601 E.Saxelton Ave. 300 West Oak Street 124 Sycamore Street 205-West 9th Street, Stockton,California Lodi,California Manteca,California Tracy,California cs 9 FIE:VISCCI 8-59 3M 3"63 F.P.C13.