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FOR OFFICE USE: --------------- - APPLICATION FOR SANITATION PERMIT Permit No. ------------- i ------------------ ---------------- -------- ---- --- ---- (Complete in Duplica+e) Date Issued ____g1j114 ---------------------_-----____---_-------__------------- This Permit Expires 1 Year From 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. B Ekf 04 O 7-U,Z"ERS JOB ADDRESS AND LOCATION-------- .3� : r'adX- -----'-�-3--�-------- ----------------- !_�7^�_Q/�/ '-----`��---sem--------- ��°i' } �"� Owner's Name-----1--gr-'e 3_A_rZ_51_�-�-------•------- ------ Phone___-•------------------------------- Address........---------- apA_I _G 3 r . PhonContractor's Name--------- -------- om-------------------------------------------------------------------•-•-- ----- . Installation e--- -�'-• will serve: Residence7K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I-____ Number of bedrooms 3-____ Number of baths __ _ Lot size -------3----- - __________________________ Water Supply: Public system ❑ Community system ❑ Private# Depth to Water Table _30 ft. �II Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ �f Previous Application Made: (If yes,date--------------------) No )b' New Construction: Yes i`� No ❑ FHA/VA: Yes ❑ No {` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---I_aQ------Distance from foundation------t_O'--------Material_-_-- � j No. of compartments-- ------- --- Size--c _h_ --?(--`�----:--_Liqui depth------- -z------_--_--Capacity--_---------,---- � J Disposal Field: Distance from nearest well----1QQ--_Distance from foundation_____ --0...-_.....Distance to nearest lot line_____ ,S [�( Number of lines-----------/----------------------Length of each line-------------&'-- ___--_.Width of trench-----------�_5/..:.......... �1 I Type of filter material-.5r- �-Depth of filter material___---/ _'_.__-Total length________________________4(,!;�__________ 7 Seepage Pit: Distance to nearest well---------------------- from foundation-------------------Distance to nearest lot line___-___-__--_-_ .� ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------- ------Depth---------------_--------------__ Cesspool: Distance from nearest weft-----------------Distance from foundation------------.-------Lining material-_______----__--________-___________. ❑ Size: Diameter--------`-----------------------------Depth-----------------------------------------------------Liquid Capacity------------------- • -----gals. Privy: Distance from nearest„wel------------------------------------------------- from nearest building_____________________________-__--___-_. ❑ Distance to nearest'lot line---------_1____________--.-_- --*----------------------I�------- ----------------- Remodeling ----------------I--------------------------- ------------------- -------------------- - �d Remodeling and/or repairing (describe):------ ---------r57eK ----- -� ------ ---•-� -------- -------- ------- --------AH_AG” ay- ------... ---'-- - ---------------------- I ii 1, - ----------------------------------------------------------------- ---------------------------•--------- Thereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,,and,rufes and regulations of the San Joaquin Local Health District. (Signed) - --�-- ° ------------ ____________ ____-__s_ (Owner/and/or Contractor (Ti+lFgY� e)----------f_� (Plot plan, showing size of lot, locati6o — ion �-. to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - -`fS--------------------- ------------------------------------------- DATE- '3-1--:- ------------------------------- REVIEWEDBY----------- `------------------------------- ----------------------------------- ------------------------------------------ DATE--- ---------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------- `---- -----• ` --------------- DATE-------------------------------------------------------------- Alterations and/or recommendations:------- ------------------------------------------------------------------------------------ ------------------------------•---------------------------------- i ----------------------------------------------------------------------------------------------------------•--•------=---•---------------------------------------------------------------------------------------------------- 1 .. FINAL INSPECTION BY: �� ' ------ -------------------------- Date----- - -- --- - ---------- SAN JOAQUIN LOCAL, HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California rs 9 Rrviai= B-59 3M 3-'63 P.R.ra.