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FOR OFFICE USE: ------------------ -------------- Permit No. '� APPLICATION FOR SANITATION PERMIT --- •• --- -------- ---- ---- (Complete.in Duplicate) Date Issued __I!_- .,?-Z:"617 ----------- - - -- - - - -____ .__h._.. 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 descried. This application is made in c.�mpliance with County Ordinance No. 549.. �11.�!__ __.._, - JOB ADDRESS A LO ATl '/ """-" " Phone. � �1� ---- ��' C� Owners Name----�.r---- �--- •-� -�-r--�7---�-�-�-------------------------- - ------------- - ------- - { t Address 'I .... ----------------- ---------------------------- " ...- -- Contractor's Name_ � {- -• -- { `�'K' - __.--- Phone_"(------- ---- dp J Installation will serve: Residence's Apartment House El Commercial E] Trailer Court ❑ Motel C] Other E]1 Number of living unify: -1---- Number of bedrooms----- Number of baths _ °.___ Lot size ._.__ _._ - !'- ---- Water Supply: Public system' E] Community systemgr Private ❑ Depth to Water Table_ ft. �h Character of soil to a depfh'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made:il�hf yes,date_____________________1 No ❑. New Construction: Yes,g] No FHA/VA: Yes ❑ No ❑ Ale ov TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available-whin 200 feet.) � `�` Se tic:Tani- Distance from nearest well-_______________Distance•fro .foundation_.-_.____________-.Material__-___._______.________-_.._________..: j'3�t-{- 1! :size Liquid depth Capacity ------- n� No. of compartments -- " 'J -'.M Distance to nearest lot line_________ bis osal Field: Distance" from nearest well from foundation____ ______________ �� - - , Numberof lines------- ---- i----- Length of each line__-�-~-1 j--------W�dth of trench.--- �� - ---"_-�-- �� cam—►� ( Type of,filter material -Depth of filter material----1q________-----Total length--------------_____-._______ _>�-- -- �� !-____.Distant o nearest I line____-- --- ' Seepage it: I Distant i to nearest well_ _�Q_0____Distance from f��°°undetion___.__ s � Numbed of pits----I-----------------Lining material-_. _�)C.r%u_--Size: Diameter._- �. _--_--Depth__----------t .-------------- f - 4 Cessp oo {: Distance from nearest welL________________Distance from foundation_____------_._____.Lining material-------------------- _'______.._.. , ❑ Size: Diameter--------------------------------------Depth-------------- -------------------------------------Liquid Capacity----------------- ---------9 Privy; Distance from nearest well-------------------------------- -----------------Distance from nearest building-------------------------------------J- E I Distance to nearest lot line- - -------------- -- ---- ----------------------------------------------------------- _ Remodeling and ,or rep,iri'n describe :- ------------------ -----"-------------- ---- ---------- --•------------ -------- ------- --- --- g ----------- -- Ihg ------ - ---------------- ----- --- --- ---------•---------------- -------------- -------- - CJ Y R '°�. -- - - -:---- i ----------------------------------------------------------------- ------------------- - - tIIS ------=--• - ------ ---- ------------11 -- cer#Ify tliat�l�have prepare t is application and t at the work will be done i ccordance with San Joaquin County ordinances, State laws+a. rules and regulations of'the San Joaquin Local Health District } oUa ' nV1 "�'.'° - � ------� or Contractor) (Signed)------ SEfi?'frC'yTX�N}{ SET�V3CE 4 i ---- -------- ---------- - ------ -------- --- ---------- 4 Ii i32915•--.Miner Ave., H0.6 3847 ---- --- -------- - ---------------(Title)____-- Y� : (Plot plan, an size of�'lot, location of system in rel#tion o ..ells, buid in s etc., can be placed on reverse side). FO.RrDtPARTMENT USE ONLY .r. .._- Y 4 APPLICATION ACCEPTED BY - ------- ---- DATE - IEWED-BY-!--- ------------------------------------------ ------------------------- 1 = DATE :;----------------------------------- REV _ = " - � ,----------- _ DATE - - BUILDING PERMIT`ISSUED------------- -- -^ �I I Alterations and/or re�comr a tions:="-------=' `=-`-------- --------------- -------------------------------- ---------•--------------------------- f ----• ' .� , 11--------------------- ----------------------------------- `'-.___._,... _. - - - r ' ," i --"- --•- -" ------------------ ------- -- a I ' �z ° :� f ----- --------------------- — -------------------- ----------------__----------------------------------------------- — �a FINAL INSPECTION BY:..-........ �---E - '-G-/��<4�C�- ------------ Date-------- T Q -17-- ----------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha Iron Ave. Soo West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California _. Manteca,California Tracy,California