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FOR OFFICE USE: ' ---------------------------------------------- -------- _--_- ---------------_..........____.. APPLICATION FOR SANITATION PERMIT Permit No. _. . --.----------------- (Complete•in Duplicate) ...._ This Permit Expires 1 Year From Date Issued Date issued _�l_- 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 Ordinance No. 549. JOB ADDRESS AN ATIO .------- ---/ ��(\'�(f�� 4 �.. - ----------- ........... / C Owner's Name -----• ~ ----- --- -- Phone: Address "dk 'L'--- f }S-T -------- -- - ------------------ ---•---------------------------- ----- Contractor's will >-- * -�1-�_ "et ...... Phone-- ta--L7- -71__ � Installation will serve: Residence [<ApJtment House ❑ Com ercial ❑ Trailer Court ❑ otel ❑ Other ❑ Number of living units: __/___ Number of bedrooms Number of baths__. ___. Lot size Water Supply: Public-system❑'Communityqystem 0 Private gj ,Depth to Water Table _oft TM ff � 4 Character Asoil do a depth of 3 feet- Sand ❑ Gravel ❑ Sand✓y Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-.- #___ ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF, INSTALLATION AND SPECIFICATIONS: septic-tank or cesspool permitted-if-pu 61ic-sewer'is available within 200 feet) is a�T k:' — istance from nea'restxwell- " ____...._Distance from Obw.Fdaf ion-------- _ Material -------------------------------------- -------- No. of compartments- ---------------_`___Size_-- � Liquid dept „---- ----- - -------.Capacity--- - ------------/ Dis osal eld: Distance from nearest well ---- Ii____ SGB -- Number of lines��. __ __ Length of each line-_. >��----- Wi`d'th"of�tr�ench �'- ¢- } Type of filter mater- _ :Depth of filter material- If Total IengtR --------------------- 'd ____________________ S', See a e Pit: -,Distance to nearest well../."- _ -Distance om f'undation___.._c��._Distan e to nearest lot line_,4��__ ' '. Number of pits.-I-----------------Lining material-__-_- �. �F-.:Sia: Diameter---_o ��--Depth- - - --------.___-- z Cesspool: _.. „, .Distance-from nearest well ----------------Distance l undation-------._"_._F_"..Lining material-.-..-.___-.-..__-.._.-_-_--__--..__ Depth- - ----------------- -- ,- Liquid Capacity. - als. 1 ' ❑ Size: Diameter. .. .------- : 9 Privy: Distance from ne'arest ----------------------------- Distance from nearest building-------------------------------------- Distance ---_.---_---._-_-_ - __--.___.-Distance to nearest lot line --------------------------------- ---------------------------------- - - I t - Remodeling and/or repairing (d cri e):--------- -------- -- - ------ ------------------ --------------------------------- ------------------------------------------------------ -------------------------------------- ----- --------------------------- ------------ ---------------------- - --------------------------------------- -------- ----------------------------------- ---------- -.- •-------------- ---------- - ---------- --- ------- - - - ' - ! ------------ - d - - ------------------------------------------------------------------- al hereby certify that". have prepared this application an that the work will bed a in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local,Health rDisfrict.. t r f # (Signed)-- ... .1 �yrr - ` '( " {�* Contractor) - a TiAi K=S `Rlt7'G" s ._A#0! '�,�. '` F'="�_{Title].---------- a -- ,(Plot plan, �t�gllfiLtsr�Vv�o#, Itt90f system i elation}to ells,,:buildings etc;can be placed on reverse side). ` FOR.DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY---- --- --------------_- - ------- ------- ------ DATE-- -lQ-_'"��_`�- -- �---------- ---- *REVIEWED BY ------ ------------------- . DATE.- •---- --------------------- --------------------�------- ----------- ---- i. BUILDING PERMIT ISSUED-----.-- -------------------------------------- ------------------------------------- ---------------- DATE--------------------------------- I Alterations and/or recommendations:---------- ---- - -- -------------------- -------- -------------- ------------------------------------------•------ --------------------- i r , FINAL INSPECTIO t Date_..--- 1. .. ------ ------ ---- ------ �} 7 S-1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 105 West 9th street Stockton,California Lodi; California ,. Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press