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R OFFICE USE: ` `P>P1ICATION FOR SANITATION-PERMIT Permit No. ..... ...;.._.__'...,. f-----------'------_-— (Complete in Duplicate) 3 7 __..__ ° This Permit Ex ires 1 Year From Date Issued Date Issued ________/0_4 Application is hereby made to the San Joaquin Local .Health District for a permit to construct and install the wori her in described. This application is made in compliance with County Ordinance-No. 549. ` 7. /� 4v -------------------------�---��``-- ------ JOB ADDRESS AND LOCATION-------------------'-� ---------------------------'- -'-'--------- /v�= ------ Phone------------------------------------ Owner's Name______. ' — Address-----------_----------- ----------------- -•---------------------•--------------------------------------------------------------------------------•------------------•------------•- Contractor's Name-- ----------- -------------------------------------------- Phone--.----•--------•-•---------------. Installation will serve: ResidenceApartment House LlCommercial ❑ Trailer Court [IMotp! E] Other E]Number of living units:---(--____ Number of bedroom_._._ Number of ba -_ Lot size _*1d4?_112_-0--a---------------------A---------- Water. Supply: Public system �-ommunity system El private E] Depth to Water Table ---0. ft. i Cha rActer of soil to a depth of 3 feet: Sand ❑ Grave l'❑ S y Loam E] Clay Loam lay ❑ Adobe E] Hardpan Q. Previous Application Made: (If yes,date.....-__..__..___..)' No New Construction: Yes No ❑ FHA/VA: Yes No ❑ --TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic;en Distance from nearest well_.0---_:Distance from found ation___��__________Material__ No. of compartments-.____.-;F _ '�-lU__'_.__Li uid de th__.�.(- ------------Ca acit lid -------- - Size---- --- - - q P -- P Y---=---'------- 1 6q__r________._.Distance to nearest lot line________________ ,� �Isposal Field: Distance from nearest we4 U____--distance from foundation.. - ' [ Number of lines---------_e�L .._.Length of each line____��-"---------------Width of trench2:1�____,___---:--__-____.__._ Type of filter material_ n4_ ------Depth of filter material_//______________Total length____-/-�C)---_.__-___________------ - Seep g tt: Distance to nearest well_?0- ----------Distant om foundation-19------------Distance to nearest lot line,--____._ J I _._:Lining material___. . . �___-Size- Diameter-- - -------------Depth---- - Number of pits_-----�- ---'------------• � Cesspool: Distance from nearest.weld_________________Distance from foundation------------------- material__:- _____-__________ ____-.1771 Size: Diameter---------------------_--------------,Depth---------------- ------------ -' liquid Capacity----------------------- gals. Privy: _Distance.Gm nearest well--------------------------•----------------------Distance.from,nearest building._________._____--.___________--.----'---' , . Distance to nearest lot line.____.__-- _-______ ------------------------------------------------ F1A ' -------------- I Remodeling and/or repairing (describe)_______ ________________ I --------------------------------- ! ----- ------- -----------------•----------------------------`--------- -------------------------------------- --------------------------------------------- - ------- ------------------------ ---------------- I hereby certify that I have prepared this ap 'cation nd that the work will be done in accordance 'with San Joaquin County ordinances, State laws, and rules and regulation the an Joaq 'n Local-Health District. I ; (Signed)----------------------------------------------------------------- ---- --- - ----------- --- ---------------------------------------------------------------(Owner and/or Contractor) hBy:------------------------------------------ ------ - ----- -------------- ------------------------------------(Title)----------------------------------- ------ (Plot plan, showing size of lot, locati syst t relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / / APPLICATION ACCEPTED -BY___._ __ — / �/ c`y" =' - DATE- === )� 5--;-1---- REVIEWED ;-- REVIEWEDBY------------------------ -------------------'•--------'-------- -------------------- --------------------------- DATE------------------------------------------------------------ BUILDINGPERMITISSUED------------------------------------- ----~'------ ------ --- _------ DA•TE----------------------- :-----------=------------------------ Alterations and/or recommendations:--_� -1�C--'------?--- `------- . .........Z `-``= -----,--------' ------------ -- - . - ---' , ---------------------= ------ –rr r�!L�- `' `–?—C�`� ......... _Z1 ��C'�•c`L-jr� 'y � rte' -� — F1NAL INSPECTION BY:_.__._s............ -..- �� -- � P 1� SAN JYS?..t 1N LOCAL HEALTH DISTRICT ��,�� ic < 1601 E.Maielton Ave. 300 West O 124 Sy more Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3-'63 f.P.CD - I