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OR OFFICE USE: -is ------------------ - _trN..__�Gr'G` _____ APPLICATION FOR SANITATION PERMIT Permit No. .../k.��. --------------- (Complete in Duplicate) fl �� Date Issleed .__ ------------------ ----------______.___-_-_.... I This Permit Expires J_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 OrdinSaqpNo. 549. JOB ADDRESSC6ND LOC TION.... Owner's Name-- ------------------------------------------------------- Phorfei---6..V=,0 Address---------�j�----.��_/-/i -- - ----� �yJ•--------- ----- - -- - •• ------•-----------------------.--------------------------- / .................. Contractor's Name-- --- 04-y--- '-� 1��-----------` �1 r L-............................................ Phone Installation will serve: Residence Apartment House ❑ Co mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / Number of living units: _/___ Number of bedrooms ._ ___ Number of baths ---/-- Lot size ....4.,�.-..-Y...1 _ ___________ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Tabl&SOft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is a ki Distance from nearest well________________Distance from foundation____.__..__.___-_-.Material------------------------------------------------- No. -________-__ ____---_----_____.-._-____. / No. of compartments--------------------------Size----------------------------.__.Liquid de th__--_-_-_----_-.-__---__-Capacity q of D�sgd: Distance from nearest well___,,# 60.-Distance from foundation...! ----------Distance to nearest lot line.....Ire Number of lines-------I____ ________ __ __ Length of each line -.44D !-----------Width of trench--j-4*4 _-_ [J ,t•- Type of filter materi ---_Depth of filter material /-.V-*4--______Total length---------------- A------------- it CYC P�_.._..Dista`Distance to nearest lot line ---------- 4a � g it• Distance to Weare well (____._Distance tom foundation__�._ _ Number of Its____ ________________Lining material__ _ a_ch --------Slit; la meter-_- fJ Depth__ ,. .............. Cesspool: Distance from nearest well_____________ ___Distance from foundation----:---------------Lining material----------------- _-___-___--_-_ ❑ Size: Diameter--------------------------------------Depth,--------- ------ --------------Liquid Capacity----- ---• gals. Privy: Distance from nearest well-__________________ _ _____ _________--Distance from nearest building--_-___---.__ -________.:.- ___-___..' ❑ Distance to nearest lot line--------------- ------------------------------------------�-----•----- :-: -•------•-------------------------- ------ .. A Remodeling and/or repairing (describe) -- - ......j-- -------` --•-- ... ................................--...... fi - ----------------_-------- ----_-------•---------------------• : ::_:_: 1a A------_----------------::::::::::------ � 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ittfe laws, and rules and /reegulationstooff`the San Joaquin Local Health District. �"�L .L�. .�__t._ `� arc_ a ,, ____________________ Atdfoor Contractor (Signed) - ------ r t ---------------------- =- ---- ( �f�7 ) By:.......................................-------------------------------------------------------- ------- (Ti+le)-------------------------------------------- ----- (Plot plan, showing size of lot, location of system in relation to w , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- = G;e--- --------------------------............................._ DATE------ --- ---------------- REVIEWEDBY-------------------------------- ------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------------- --- Alterations and/or recomme ations--------------- --------- /=/ -`---------- 4 - ------------------------ .----- - ---------------------------------------------------------- ---------------------- -- -------------------------- ------ f� ,r FINAL INSPECTION BY:-------C` ��'�------------ --------------------- Date----------L--://.-L ------------------- --------_-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 Wens Qlwt Street Stockton,California Lodi,California Manteca,California Tracy,Cafiforp' ES 9 REVISED B-59 3M 3-'63 F.P.CD.