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FOR OFFICE,USE: „ y4 ......... APPLICATION FOR SANITATION PERMIT Permit Na. --- -- ••"�`� ` =a:. - 3 -------_ Y �-=- -- - (Complete-in Duplicate) - � ------------------------------------------------------- This Permit Expires 1 Year From Date Issued M� � - Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to const ct and install the work herein described. This application. is made in compliance with County Ordinance No. 549. sl 4> • 4 JOB ADDRESS AND LOCATI N.----15560I_...�- ---- + C-14...... Nle A --------------------------- p-Pd 4-"----- Owner's Name--------=------- -------- ,Rf D ------F----------- - r>i"f � �-1 ------- ------.--.- Phone------------------------------------ ' Address------------------�- •?�-------W----."/V�AW..._..-------R)._P©N-------------------------- ;------____..___-...----_,.__..______.___.------__.______------------•--- Contractor's Name------_OW-N_F-12-�.-%---------------- ------------------------- --------------- ------------------- ----------------- -- - Phone------ .-------•--•-----•--•------- i Installation will serve: Residence ®'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�_____ Number of bedrooms _ ._ Number of baths _ Lot size 4- Number __--_-- Water Supply: Public system ❑ Community syst m ❑ - Private Depth to Water Table 0�_ ft ECharacter of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Pre4ious Application-Made:- {if yes date__-- ...TI.Noew Construction: Peso ❑ FHA/VA: Yes.r�No ❑,\ G TYPE OF IN57AL(ATIQN.:AN_D_SAECIFICATIONST�_ ._. .....T, _ i (No septic tank�or cesspool per if public sewer is available�within�240 feet.) Septic ink: Distance from nearest well__Jam _..__Distance from foundation_. .-....... Mater al Q C, II✓ -- -----_ 0 p ---------------Size_yX fiO_-K- i----Liquid depth---• -Z ----Capacity--AP-©------ Disposal Field: Distance from rnearest well_..•5- ___._Distance from-foundation_AQ__.__.___`Distance to nearest lot line__ — 4 ---- ®� Number of lines--------- -----�— f -_--_Length of each line__.---/V0- f Width,of trench._.__ ' .--` -- --------- . .:Type of filter material_ IRQ._05�_Depth of filter material.....t��, Tofal length_--_ --.---2Q©------------------ n_ a� l w 4 See a ePit-.: Distance to nearest well.............+__..._--Distance from foundation--_._.__________.Distance to nearest lot line----------------- p g �.�. _ � ❑ " Number of pits--- -----------------Lininrateria---------- -------- Size: Diameter-----------------------Depth-.-.-.---- --------------- ------ Cesspool: Distance from nearest well ._.------------Distance from foundation................. . Lining material------------------------------------- ❑ Size: Diameter- -- --------- --- ------------.L.--.-Depfh—------" - ---------------------- Liquid Capacity---------------------------gals. Privy: ,Distance from nearest well------------- ----------------------- --- Distance from nearest building Distance to nearest lot hre -----------------------------------------------------------------------------------------1 1-11 Y4_:,_4 Remodeling and or". r --------------------- ------ -----.'�" ---I � ------t'�'°� hf tq- -� �- � ��_.CI �� ------------------------- ---- -�-�`--�--? ,--- ---- ------- - ---- - --------------------- ----- -----`- i -- -------------------------------------- -=-------------------------- -------------- - f ------ =-----------------•----------------------------- -------------------------------------------------------------------------------------------------- hereby certify at I have prepared_f •s_application_and-fhat the_work-will-be_done-in accordance with San Joaquin County ordinances, State s, and vt4es and re at ons o the San Joaquin local Health District. i (Signed)==-=•------ = --- :.=:(Owner and/or Contractor) �$y:-------------------------------------------- �"=��- . ..... ..... ... ---------------------- (Plot plan, showing ,size of lot, location of system in relation to wells, buildings, efc.,'can be placed on reverse side). ,FOR DEPARTMENT USE ONLY I r E QAPPLICATION ACCEPTEDBY - --- ---------------- ------- DATE...... REVIEWEDBY -------:-------- ------------- -- ------------- --------'----------------- --- ---=-------- DATE---------- - 'BUILDING PERMIT ISSUED-------- -- --•----------------------- ---------- --------- -•--------- - ----------- DATE--------- ----------------- ----- Alterations and/or recommendations:_---- - --------- - -------- -------- - ----- ---- ----------- ------------------------••---------- ------------------------ '""�/' � 'y _ "... Tk:7 - . ------------------ ----------------------------- -- . ----- -------- , -- --i. ------ --- --------- -- •--- - ------------------------ -`------- --- f r ----------- r FINAL IN$PECTI�N�BY �., - _" r Date ---------------------------.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t Stockton,California Lodi. CaliforniaManteca, California -�'�' r. Tracy,California E.H.9 2M 1-67 Vanguard Press 1 i