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y d FOR OFFICINSE. %. APPLICATION FOR SANITATION PERMIT permit No. /....�.-7--.�:3 ------------------^ - �--- - °t (Complete in Duplicate) / � - - �-C - - Date Issued ------------------------------------_..._----------.-_. This Permit Expires 1 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 Ordinance No. 549. ; �-- -- - --------------------------------------------------------------- •JOB ADDRESS A O TION_._.__.-'��.. .. 1 GaG�'-_9,.1,--0e'� �----------- Owner's Name ---------•-------------------------- Phone...: t Address----------------------- .•-� ��.. �� '!_l .�-- ----------------------------- - ' Contractors Name--- � Phone. ' _ ------------ Installation will serve: ResiC�nce Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ . their;❑ I qtr .... �- I Number of living units: _.._Number of bedrooms=.- l- of baths Lot size _. �cQf_ .1. .. ---------------------------- Number Water Supply: Public system 2--community system ❑ Private ❑ Depth to Water Table ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ I 1 Previous Application Made: (If yes,date-----------.--------1 No Cp` New Construction: Yes o ❑ FHA/,VA,. Yes ❑ Ngle� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) 1 YI C k- Septic'T�rk:� Distance from nearest well....... ..Distance from foundation.-.- -..-..-.MateriaL.._h - ---- ------------------------ �� r .Size._.Sa-. _ -_�...____Liquid depth____.�%_____Capacity_.._ .-._ _-- L. No. of compartments �- -- _-q g /r 1 l . p Number of lines Q��.....� Length of each line.__...... ,0._�.-_......Width of trench. ' Die Deal field: Distance from nearest well___ .. to nearest at ` fi Type of filter material ,,.Y 'Depth of.filter material . .=...--.Total length.._..... 0 Distanc m foundation_.... ..0_:.-__.Distance to nearest lot li �j J Seepag i : Distance to neares well.....-~��'...... _ � � __ � � ne- �-.- 'J �� p ---1 g - �J._...--- p� a t 4- Cesspool: of its.-- Linin material...-. .-_ ___.Size: Diamete .. ---- De th=-. ..__ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material!-------.---------------------------- F ------------------ -r Dlr pt ---------------- �-- ----------------- -----------Liquid Capacity---'----------------------gals.❑ O Privy: Distance fromnearest --------- Distance..#rorn,:nearest building------ ?_'_:------------------------------ -- I ❑ Distance to nearest lot line ----------------- --------------------- --------=-------- ----------------------- rRemodeling and/or repairing4(describe):---- - ---!--__� — i�"A-I lL.t_/-------I•---------------------'---------. ----- --------------------�:_'L1=r......--..-_.........._.........----._._.___-_.-----------._-------..._..._-_......._-..._._-.--•------.-_.__.._.._.......--_...___--..-.---...__.-.:----.-._-----------.--._...-.:-..._..re -------------------------- -- -- -- - ----------- r_-- ---------------------------- ------.---------------_------------------------------------------------------------ ------------------------- -------------- ----_------_--_..__._-. _ I hereby certify that I have prepared this application and that the work will be done,inaccords c^ewwith/San Joaquin County O ordinances, State I s, nd rules aha ;re �7-- aquin local Health bis#ric+.(Signed) ---- - ------ ---- ---------------------------------:--------------- (Owner and/or Contractor] BY� --------------------------(Title)------ (Plot plan, sh6v ng size of ation of syYrLn .n relation to we Ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATICNt ACCEPTED- BY- ' '__-- �" _.. .. .. _-- f . - --- ----. -- - ��.--'�.�_------==--==------------------------------- DATE-=---7/=---i --- ---- ----1------------------- REVIEWED ------------ - - REVIEWEDBY---------------------------•-----.�---------------------------=---- ---------------------------------------------- DATE--------------------------------•---•---•----•---.-.-------- . BUILDING PERMIT ISSUED--------------------------------------------------------------------- - ----- DATE.---- -------------------------------------------------- Alterations --------------------------------------------- --Alterations and:/or recommendations:__.._.. .,/ fQ -r`----'---=---- mac -----------------------------------------------------------------------------------=-------------------------------------------------I---------------------------------- ---------------------------------------------------- --------------------------------------------------------------- ------------------------------------------- -•---------------------------------...------------------------------------ --------------------------=---------- r�NJOAQUIN � � r� � f FINAL INSPECTION BY... - -- ---------------------- Date - ' ----------- ---------------•---- 'S LOCAL HEALTH DISTRICT i 1601,E Wazellon Ave. n � 300:West Oak Street 124 Sycamore Street 205 West 9th Street >tStockton,CalFFornfa'`" Lodi;`a[if o`rnia ,.4 —,�. ''Manteca,California Tracy,California } u Es 9 Rcvscrm B-s9 3M 3-'63 r.P.00. "