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FOR OFFICE USE: ------- --------- ------- Permit No. 6.(. - _'at -------- APPLICATION FOR SANITATION PERMIT ---------------------------- This Permit Expires 1 Year From Date Issued ------------- - ------ --------- (Complete in Duplicate) 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 Ord' ante No. 549. r JOB ADDRESS AND LOCATION_ _Jq .. V - ----------- k L ----------------- _ Owner's Name ------- --------------•....... -------------------------------- ------------------------- --------------- Phone- ;1!-------------- Address --- ------------------ ........... --------------- ----------------------- -------------- ------- -------------------------------------------------- -4 ----------------------------- Contractor's Name_� �z ---------------------- --.1 ----- Phone --o ... 6. Zlii Installation will serve: Residence [Er -"Apartment House Oj C mmerciai 0 Tr 'I Co'rt [] Motel [:1 Other [I Number of bed Lot size --- Number.of living units-. rooms umber of baths .7 & ..... . ---------- 4- Private Depth . to'Wate'r'Table"V. ft. Water Supply: Public system lid Community system 0 va te E] Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam E] Clay Loam E] Clay 0 Adobe Hardpan 0 Previous Application Made: (If yes,date ----------- 7 -------- ) No ❑ 'New Construction: Yes E] No FHA/VA: Yes E] No El TYP OF IN�ST41LLATION AND SPECIFICATIONS: septic tank or cesspool permitted. if public sewer is available within 200 feet.) 9' INS so, JT Tan Distance from nearest well_________________ Distance from fciu,clafici - ------------------- Material ------------------------------------- ----------- No. of compartments ------ : ---------------- .__ Size -------_-_--------- Liquid depth---------- -------------- Capacity ---------------------- Or os Distance from nearest well_ALI� ... Distance from founclation/49 ............ Distance to nearest lot line--. --__-_--_ Number of lines._____ Length of each line --- 4-1-D --- ----- Width of trench___- -------------- 9-0 - _-ON --- p .0 ----- ------------------ 4- Type of filter material_.__._ --9� ------ --- Depth f filter'material --- Z_S ------ Total length ------- 4��2_0_ Distance to nearest well__t�'-Vtj --------- Distance from founclatioril,& .......... Di,t,nce to nearest lot fine____ Number of its_____ Lining' mate _.__.Size: Diameter_ 15- Z -- ----- Depth ----- �2_ 1E ---------------- Cesspool: Distance from nearest well ----------------- Distaric )'mm f f undation --------------------- Lining material_________._-_______.____.______.___... 0 Size: Diameter---------------------------- ---------- Depth ------------------------------- ----------------------- Liquid Capacity -------------------------- _qals, Privy:! Distance from nearest WO -------------------------------------- --------- - Distance from nearest building__________________________________._-----. ❑ Distance to nearest lot line-- ---------- - ------------------------------------------------------------------------------- ---------------------------------------- Remodeling and/or repairing (describe): --------- -- ------------- 1– ------------------------- . ...... -11 ---------------------------- ------------------------- --- ------------------------- ----------------- -------------------- -------------------- ---------------------------------------------------- -- -------- --------- ------------- -------------------- -------- -------------------------------- -----_------------ -- --- ------------------------------------- --- ------------------------------------- ------------------------------------ -- ------------- ---------------- - ----------- ------------------------------- ------ V --------- ------------------------------- ---------- I ------------------------------------------------------ I hereby certify that I have preparoed this'applicafion and that the work will -be done in accordance with San Joaquin County ordinances, Sla�51aves and rules and re ulations of the.San Joaquin Local Health District. CSi nedontractor By:------------------------------------------------- k_C4 ------- ----- ---------- ------------- ------------------------- By: ---------------------------------------------------------------------- Title) ---------------------------------------------------------------- (Plot plan, showing size of lot, location of system inirelation to uildings, .7i(., can be placed on reverse side). FOR DEPARTMENT USE ONLY A P APPLICATION ACCEPTED BYL�` ------------ -- ---- �_ -----_----------- DATE ----------- - 9 --- --- ----- — -------------------- ----------------------------- , 11 + REVIEWED BY ------------------------------------------------------------------------------------------------ DATE ------ ---------_------------- --------------------------- BUILDING PERMIT ISSUED__Z ---------------------------- : --------------------- --------------- DATE ------------------------------------------------------------- ------------- ---- -- ---- --- Alterations and/or recommendafions:./--Z-, ------ ------ ps --------- -- ----- — ----- ------ ------------------------------------------ - ------------------------- ----------------------------- -------------------------------------------------------- ------------- ------ ------------------- -------------------------- ----------------------------------------------------------------------------------------- FINAL INSPECTION BY. ---- Date ------------- ----- -------- - �/ -------------------------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California Lodi, California CE -9 REVISED B-59 r.PX0. 2N! 6-60 IN 124 Sycamore Street 205 West 9th Street Manteca, California Tracy, California