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FOR OFFICE USE: ` -G-� ----------------------------- - e' _ /--- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. cP-��.�_��-�-. � �f/j ----- (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 LO ATION- '"fG 3 ----- 4 % a- -- - - Owner's Name---------------- -------- ^ - Address----••----- Contractor's Name------- Phone._1f.._g l_.__.-:'_3 g_l_o_.z/ v �!f� y Phone 21 Installation will serve: Residence lk Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_ Number of bedrooms __%7_ Number of baths __/ Lot size -_-14��---------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table/442 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe ❑- Hardpan Previous Application Made: (If yes,date--------------------) No New Construction: Yes �o ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septic T k: Distance from nearest welly f Distance from foundation---/_16_ Material L— f L No. of compartmenA------OZ-------------Size_�/4.Xs`X9__Liquid depth-_._1 �- _---_.----Capacity_A-170 p _4„-4�' gyp % Disposal F' Id: Distance frommearest wefl.�?�.___.-_Distance from foundation__ ________________Distance to nearest lot line___________.__... Number of Dine___ ___ _- --- -Length of each hne'�O_____, 4-,e74_,X&Width of trench'?.._____.__... } -, i - f _______ Type of fter materi-al.---- �d_ �Depth of filter material length _-------------------- - r - Seepage st: Distance to nearest well__14D--------Distance m foundation____�_ --,_Distance_ Distance to nearest lot line------ \4N\ Number of pits---z:,-------------Lining material__/��U_ _ __Size: Diameter-------- _3-- -.Depth....----a-eS-----_--__.____ Cesspool: Distance frefm nearest well-----------------Distance from foundation----_-------____---.Lining material-------------.---___.___.__._________- ❑ Size: Diameter--------------------------------------Depth-------------------------- -------------------------Liquid Capacity----------------------------gals. , Privy: Distance from nearest well --------------------------____-------.----.--i'Distance from nearest building.__._...__.-_----------______..___..__.. ❑ Distance to nearest lot line-------- --------------------- --------------- -------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------- "uC------------ -- - ------ -- �------ ------- LC<G'7`2 ----- - ------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I --------------------------------------------------------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, S to laws, and rules and regulations of the San Joaquin Local Health District. s (Signed) Owner and/or Contractor) - - - - - F. -- - By------------------------------------------------------- �in ---- -------------- - -------------(Title)- - (Plot plan, showing size of lot, location of sytion to ells, buildings, etc., can be placed on'reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE --------- ------- REVIEWEDBY--------------------------------------------- ------------- ----------------------------------------------------------- --- DATE------ ------------------- -------------------------------- BUILDING PERMIT ISSUED------------- - --------- DATE--------- ----- Alterations and/or recommendatians:__ __.._� _/.® _s7 '________________ _ _..______ i -- --+�- -- -- - -------------- a FINAL INSPECTION BY:_. -- Date-------- / -- - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' Lodi,California Manteca, California r Stockton,California Tracy,California F.R.c o. }