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FOR OFFICE USE: ---------_--------------------- APPLICATION FOR SANITATION PERMIT Permit No. f� /y _ (Complete in Duplicate) Date Issued ___— (L.'_. _'__ -.--. This Permit Expires 1 Year From Date Issued �•6 -- _ _ .. Application is hereby made to the San Joaquin Local Health District for a permit to-constlruct and insFall the work erein escribed. . This application.is made in compliance with County Ordinance No. 5 . jt1 ,� C7'�-d3�-1{0 1 - .2� �L I e 1 � Iva JOB ADDRESS AND LOCATION. - ... ` - -------- A oma R W - r -.j!'... ' /GJUn/i /i'" pf Owners Name - d - -------- ------------------------------- Owner' - P 8 ; Address--- -------------- ?/ l ----- -- --------------- 001/ '�-� I� - �D,s ax Crib LT Contractor's Name---------- --------- Installation ------• - �" �$� f Phone........ , Installation will serve: Residence Apartment Ho se ❑ Commercial ❑ Trailer /Court ❑ Motel ❑ Other [] ' Number of living units: ----- Number of bedrooms 4-_ Number "aths _. '__ Lot size ____-Q. s..eR,�—_---- y ❑ y y ❑" ! ,Depth to Water Table -------- ft. Water Supply: Publics stem Commuriit s stem Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑- Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------- - ------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ..t t ' (N -septic tank or cesspool permitted if publics wer is available within 200 feet. Se tic ank: Distance from nearest well___—157 Distance from �ndat• .Materia_..__-__ -. __ _ p r No. of compartment_ id�dept,__--__ --------- Capacity ' r ------- Sizelr _ Ca aut �- Disposa ield: DisfQnce from nearest well--.., 5 __t_Distance from foundation_---�o---.---- istance to nearest lot line----..----- ' q j� Number of lines----:�_.-.-.--___ _.___-_Length of each line/ _"". h�� Width of french._ .__ ___________________ Type, ofwfilter material___., __-Depth of filter material...jJ'_-_-----_---Total length__�FaC----------------_`-_- , ;Seeps Pit: Distance to nearest well-_/Q-Q_.-__---Distance from foundation------,f O__--..Distance to nearest lot line_.�_._____ -91 Number ofits.... Lining material..d:.R--------Size: Diameter_. .-.-Depth......=:Z�__.f---- Cesspool. Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter------------'-------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals. X Privy: Distance--from nearest,wel---------------------------------------------------- from nearest building.----_---_----.--_-_-_--___-_------..--_-. ❑ w s. Distance to nearest lot lme------_ - - 'Remodeling and/or repairing (describe):-------- :---------------------------------------------------------------------------------------�---------------------------- ---------------------- . } •_•-------------- ---------___ -----------_ ---------------- ---•_•------.-" R r = _ �. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County } ordinances, State laws, and ul and regulations of t e an-Joaquin Local,Health District.."k Trelati �__ _ __ /or Contractor) (Signed). `---=------------------------- - --- - -----•------------ --------------- -------- - ----------------------------------- -- r = i (Title) t T e Piot plan, showing size of lot, location of s s+em'�'ino'wells, b � s, etc. can be placed.on reverse( P g Yside}. - 1 FOR,DEPARTMENT USE ONLY APPLICATION -- '----i�"s-`-�- ATE %' REVIEWED BY ACCEPTED BY__ �t�-. ------ � -_s--=--------------- ------------------- Q .� _ I = ----------- -------- - - ----- - ---.--- - ------------- ----`--------•• DATE----------------------------------------------------- IN_ BUILDING PERMIT ISSUED------------------------------------------------ -------------- - --------`-------- ,DAT Alterations and/or recommendations:---- _. ------ "" xC ' _-- ---------- '--� ---------------------------- --------------- - `-"�---------- -•-•-------------------•--•---------------------------------------__--___._--...._. ---_-------------------------------------- ----------------------------------------•_---_-__--•-----...----_.-•-_-._.____---._-.._--.----.-_--•-----------------------_-• -,._.:._-_--_---------------.. --..__...------"i-----------_-_------------------------ -� 1 - r —---------------------•- --------------------- -------------------------- - ------------------ ----------------------------------------=:------------------------------ -------------------- ---_- -------- FINAL INSPECTION BY.,,.0;;0 ---- - --------------------------- Date f...- - ----------------------------------- ------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Ha:altan Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California s. E5 9 REVFSED 6-59 3M 3-'63 F-F-CC. Zle t } LL