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APPLICATION FOR SANITATION PERMIT Permit No. .� J�� T r (Complete in Duplicate) ... ----- -------------r•-- --- This Permit Expires i Year From Date Issued Date Issued f_.`�_�•-5�� AppCounty is hereby made to the San Joaquin Local Health District for a permit to construct and inst II the work herein described. iT Is applica#ion is made in compliance with Cty Ordinance No. 549. nEn! b 1v` C?` .r� �- dS� -CUBO, 37 JOB ADDRESS AND �OCATi& ------ -- ------- e_ ' 4 -Owners Nam '__ P *e ' -=----- v ----------- --:---- Contractor's Name - x Phone- ----- ----- - � -------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ MotelI ❑ Other,❑ +i . Number of living units: ___`_-_ Number of bedrooms _ Number of baths -__=�Lof sizeZ;tC-------------------- Water Supply: Public system .❑ C'ommun'ity system ❑ Private [!1� Depfh to Water Tabl�Xclay Character of soil to a depth of 3 feet: Sand'0 Gravel ❑ Sandy Loam [] ClayLoam ❑ Adobe ❑ Hardpan,❑ Previous Application Made: (If yes,date.---___t__._-_..___) No ❑" New Construction: Yes No t I ❑ ❑ FHA/VA: Yes 0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,. s . (No-septic tank or cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance from nearest well_ ___ ___Distance from founda#ion--__.-.______,._. _ ❑ No. of compartments_--------1-- Material____ °_ ----- ---•----------------- ---- Size----n-------- ---------Liquid depth------=--=--------- Ca Capacity.'i i 4 ty ------- Dispos Field: Distance from nearest well_\",5O_ I_-"Distance from foundation.__/p__ _____ . t f - Distance to nearest lot Iine..5_-----__•- - g Typei• Depth hof-filter,mlaterial". .�. ? Width of trench:_ ____--i-- -------- Number of•lines---------_- - _-- --!"--�_-- l1J See pa /Pit: pistanceftlo neaaestrlwelf p�__ 4,'_Dis#ance from foundation °�° Total length_- �s__�"" f" _ "" "" - � ..___.Distance to nearest,lotiine_S_ r Number of Pits...._____/_-----------Lining material_____-.-�---.-.--.Size: Diameter__-.___- Z I t r 3- Depth_ - ---------- Cesspool: Distance from nearest weif __' Distance from foundafiion. I -. --.Lining material- -------- .. ❑ Size: Diameter----------- ` ------- ---Depth_'-= -----------------Liquid Capacity---------------------- ----gals. Privy: Distance from nearest well \A_: 1 'r.4 __ "".-._Distance from nearest buildin 9 ------ =- ❑ Distance to nearest lot line------------------------------_ ----- - _ �. ----------------- R� ring escri e� - -----------------------------------------•- r.� _ L ----------------------- ------------- :-------- ----------------------------------------------------------=------------=----------------- ----------------------------- ------- =-----= - I hereby certify that I have prepared this application and thafAe work will be done in accordance ,with-San'-Joaquin;county ordinances, State laws, and rules and regulations of the San Joaquin Local Health-Diifrict. (Signed)-------- --• ----- -------- ---- -- ---- --------- --------- By• --•------ n rac --- P. , an or Plot lan, showing size of lot, location of s sfem In tela if on to wells, buildings, etc., can be placed on reverse i � { p g ------------ ' -------- y- ' y e side) A f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_--rte- �� ----------------------=-------------- DATE._L REVIEWED BY - -------- ------------------=--------.. - DATE r BUILDING PERMIT ISSUED i �t �.--- - - - - ---------------------- ' --------- --- ------------------= =- --------------------------------.. DA-TE- Alterafions and/or recommendations:-- ____.____.�".__- - ``�. --------------------------- --- - --- --- ---------------- i ----------'--------------- ------------- '._-dam,i .... --------------------------------------------- _______________________________ ------ _------------------------------------ _________ -------------- -1------------- -----------_ _ _----------------------------------------------- .--------------------------------------- ____________ ___________--fir----- - _____....__..__.______ _ _----------_________------------------------------------------------------------- FINAL INSPECTION BY: ,�' /- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 6.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California .Lodi,California Manteca,California 205 West 9th street Tracy,California ES 9 REVISED B-59 3M 3-163 F.P.CG. - - - T