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FOR OFFICE USE: - -------------------------------------------------------- ------------------------------------------------- ------- APPLICATION FOR SANITATION PERM'S Permit No. .__.•--- ---------_-/ ------------------ -- --- '----------------- (Complete m"Dupliea)q. .._. •,. This Permit ExQires 1 Year'Erorn Date Issued Date Issued ------ ------------ - --- -------------------- Application is hereby made to the San.Joaquin Local Health District for a permit to construct and inst II the work herein described. +' T his ay �i is made in compliance with Count Ordinance No. 549. t�/J• 1 3—( —(� .; r 17 JOB`ADDRESS AND LOCATION �• e Owner's Name .lf` l{ .x.. __ ! - `'------------- Phone. � �� _ Address . .. C xZ -- - -------------- -------•---------------------------------=-------------------------------- -- ------------------------------ Contract-T's Name---------._ i_----- ------ - ------- --- -- - - --------------------------------------- ------ Phon;A-------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ .xTrailer Court ❑ Motel L]' Other ❑ Number of living !nits: _- .---- Number of bedrooms _ _- Number of baths;__ Lot size ______ ______ __________ f 3 . Water Supply: Public system ❑ Community system ❑ private Depth .to Water Table/20"6 ft Character of soil to a depth of 3 feet:.Sand Gravel Sand Loam Clay Loam Cla Adobe Hardpan P ❑� ❑ Y ❑ Y ❑ Y ❑ ❑ ®� Previous Application Made If yes,dote. ik k .__1 No New Construction: Yes; No 0 FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION-,AND SPECIFICATIONS •.' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' n - # � � � ' ld-- Septic"Ta k: Distance from nearest well _� _=Distance from foundation -_.- ----------- U' ____ ofrpartment"s. y Szet ` Liquid depth ---_------------ No. --Capacty + !�v. Disposal Id: Distance-from nearest weir- 'Distance,.•from foundation fl Distance to.nearest lot „ [ Number of lines--_ r� " 'x ;Length `of ea h� ine # f 71 "'"Wath of rench.____-- -. Type of filter material) if ate. ,� ,Depth of filter material+. ..Total length____.__ __.1 _.__ See it:, Distance to nearest well------ - Distance from foundation__-___ '_. ..Distance•to nearest lot line----------------- Number of.pts ------------- Lining material_ Siz me#fer } - -__. _-.-- Depth I Distance from nearest well-- Distance from foundation-_-.-_ _-.-- Lining matenal_x_.�_ _ --------------------- Cesspool: � , ❑ Size: Diameter------------------------ Depth. F __�z Liquid tCapacity ------------------------gal _ - _ 1 X11 Trivy: Distance from nearest well _ v Distance from.-nearest building----------------------------------- El -------------------___- _..__ ❑ _ + - ---------------------------------•-------------------'-------.----_. . describe :-------- ------ -------- = --- --- =---- Distance to nearest of ine------------------------------------------- -------------------------- Remodeling and repa�r:n9 I ) --------------------------------------- ---- 3 _ ___________________________________________________v_______.______________r------------------.___----_-----__-___----____---_r-_---__-_----:---_------.--____----____-__-________---____--_-_._.---_._-__..____.____- I hereby certify that I have prepared this application and that the work will"-be-done in'accordance with San Joaquin County ordinances, State laws, nd rules and regulatibns of the San Joaquin Local Health District. } (Signed)------------- ,r -� - -------- --------------- --------------------------------- -------(Owner and/or Contractor) 1 Plot Ian, showing size of lot, location of s stem.in relation-to wells, buildings, '* can('bele placed on reverse side). ( p g y buildin s, etc FOR DOARTMENT USE ONLY] I APPLICATION ACCEPTED BY----- . '-` —- ---------------------------------—-----------}DATE Z:77 �------- -- --- REVIEWEDBY----------------------------------------- -------------- ----- -------- --------.--- -----:�`--+`0.7 DATE------------------------------- - t BUILDING PERMIT ISSUED----' 4 =� �_ `DATE. Alter io r re ommendations•-. �� _, -t'� ------ / - ---- .tp Y.rr e-.... --- --- ----- -- •. �-� _. s x / ----------------------------------- - --�.�'--- -- ------- ------ ----------------------- - ----- ---- -------------------------------------------------------=---------- FINAL-W-OSPECTION BY--------------- ---------- Date-- ----------------- ------------------------------------------------------- SAN JOAQUIN.LOCAL HEALTH DISTRICT 1601 E.Masellon Ave. 300 West Oak Street 124"Sycamore Street 205 West 9th Street Stockton,California Lodi,California 'Manteca,California Tracy,California CS 9 pEv,BEO B-SB 3M 3-'63 P.A.CQ. M