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F FOR OFFICE USE: 1 ..�`�•� �`'� � r APPLICATION FOR SANITATION PERMIT Permit No. fQ kl,5 s-------------- - - ... (Complete-in Duplicate) ...........----------------------------_-----_--_----- - ._. This Permit Expires 1_Year From bate Issues � " Date Issued _..1 _-- � 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 Ordin nce No. 549. t r JOB ADDRESS AND LOC ON �i( ,-� --------------- ------------- ----•-------------------- Owner's Name d '...... e.-s-/�------- ------ ---- ---- -------------------------- Phone Address----------------------- 7-1-7 . ...+Q� 0&-2Al� =, �..�j Contractor's Name- - .0 [' ��- i�L - j? t ' � �QIC - ------ Phone7'<diP. Installation will serve. Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __! --- Nu ber of bedrooms .AQ.- Number of baths--/.- Lot size . --�.- ../ _• ----.................. I Water Supply: Public system EVCommunity system [] Private [,] Depth to Water Table Xvft I Character of sail to a depth of 3 feet- Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ ` Previous Application Made: (If yes,date------------------- 1 No ❑ New Construction: Yes ❑ No.D�= FHA/VA: Yes ❑ No ❑ . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se f'c Tan Distance from nearest well ................Distance from foundation--------.----..-....Material __€_ _` __ To/1 If No. of compartments-------------- -----------Size------ ---- --- --#--------Liquid depth--t- ---- --- -- --------Capacity.--.------------------- bis sal F 1 • Distance from nearest well.................Distance from foundation...........-.-.-_._.Distance to nearest lot line.......---------- /7/ Number of lines-----------------------------------Length of each line.. ---------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material--------------- -------Total length----------------------------_--_------. Se q Distance to nearest welLl%�P,.--...._Distance from foundation"A__0.!------Distar a to nearest ylo�t lin�.a,2� .. { Number of pits... It._-------------Lining material-R#.c-k --__ Size: Diameter.. Depth ice- r Cesspool: Distance from nearest well ....------------Distance from foundation___ ____..------- ..Lining material-.----------------------------------- El Size: Diameter- -- --------- ----- ----------------Depth------- ------------------------- ---------------- Liquid Capacity- -------gals. Privy: Distance from nearest well-------........._-----------.- -_-_-_-Distance from nearest building � ❑ Distance to nearest lot line - h Remodeling and/or repairing (describe):------------------- --------- '- -- ------ --- a --------------------------------------------------------- ------ 10"17--•-------------- ------------------------------- I hereby certify that I have prepared this applicalioneqthat the work will be done in accordance with San Joaquin County ! ordinances, St a ws, nd rules a regulatio the Joaqui a] Health District. (Signed - ._-- ` -- ------ ---------------------------(Own ei mwd�m Contractor) { I3y----------------------------------••--••------- ----------------- ------------------- .....(Title)----------------- ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------------ -------------------------- ------------- DATE--------P:n4f �P REVIEWEDBY------ ------------------ ------ -- ----------------------------...----------------------------------------------------- DATE-- --------------------------------------------------------- BUILDING PERMIT ISSUED-------- ------------------------------------------------ ----•----------------------------- --------- DATE---- ----------------------- Alterations and/or recommendations:-------------- -- --------------------------------.-- --------- -------------------- ------------------ ---------- -: 7----- d------ --- ------------ - ------ ---- -- --- FINAL INSPECTION BY.--------- -= ---- --------- ------ S JO LOCAL HEALTH DISTRICT 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca, California Tracy,California p. E.H.9 2M 1-67 Vanguard Press