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FOROFFICE USE: ,. IM.___ APPLICATION FOR SANITATION PERMIT Permit No. ----------- - --- ----------------------- ----------11----- (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued 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 AN OCIATION----------3-0-7 �' y -------------- Owner's Na I -10 IL92. �-� ---------------------- ------------- --------- ------ ------- Phone-0------------------------- Address- t--z---- Contractor's Name----------- '! 4 e --- ------- Phone.- l® Installation will serve: .Re1.sidence [j Apartment House Commercial'❑ Trailer Court ❑ Motel ❑ Other El Number of living units: ------ Number of bedrooms ---d-- Number of baths -X__ Lot size r Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table 1A it. s Character of soil to a depth`of 3 feet: Sand)6 Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_;__________________) No j New Construction: Yes•W' No ❑ FHA/VA: Yes [71 —No TYPE OF INSTALLATION AND SPECIFICATIONS: ,,,,,r(No,sepfic tankkoor Cesspool permitted,if-public sewer,is available,wifhin 200 feet.), Septic Tank: Distance from nearest well�Disfance from foundation_. _f_ - A !-�� ' -Material-- ------------ ------------------- ---� No. of compar tmen ts..._--j---- _-,A_--j.Siz �- __ /,S-_Liquid depth------ l__`__.._.______Capacity . _%577, disposal Field: Distance from nearest weI240 istance fromLV r�,foundat:ioy�__.r �_j _Distance to nearest lot line,�oNumber hof lines---- ----------- g+i of ash Bine � -1Width of tr`ench-------3--------------- Type of filter material.s�-i__ _ . Depth of filter material--- ----------Total length-----------------:.---P�i_ Seepage Pit: Distance.�,to nearest well......................Distance from foundation--------------------Distance.to nearest lot line-_-.___--_.--___ ❑ Number�of pits----------------------Lining material--------------------__---Size: Dia meter__-.......-_-........_Depth--------------------------------- O. i Cesspool: Distance from nearest well-----------------Distance from foundation.....:_..________-'.Lining material----. ___._____.__.____------------ ❑ Size: Diameter-.--..-------------------------------Depth--------------------------- Capacity..---------^ 'Li uicl Ca - q p Y-- - --------------------gals. Privy: Distance from nearest well------ from nearest building--------------..________-----.----_-.----. ❑ Distancehfo nearest lot line----------------------- F _____________ F W Remodeling and/or repairinLclescri e,:---�Q7`------ Za------V/9-ka_1-ffNQE ----C�.,K �_ .`� =_-4 --- ------- L' f_13i1,��? -------</-TX----_6-E_VVA&Z-------4 -'5T-Eft-------- .STT � ------I--3-----y__Afzs. . ------- ?� �_ ,N_ �? Fc? ---------> ........1..- ..AIAX-- .V$EKE_ Ij &-3 CJ- I hereby certify that I hrave prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, Stat ws, and ales and regal tions of the San J quip Local Health District. :l (Signed)--------- -------- ----- -- ------- ---- -------- --- - ----------------------- --- ----------------------•----- Owner and/or Contractor) II. By: T - ------ ---,1 � �•+� .--- --- -- ---- --(Title) ----------- ``��{Plot plan, s-,-ie of lot;focafion of system inn rela'tin wells, buildings,etc., can b placed on -reverse site FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDrY- T - ` DATE ------------------------ REVIEWED BY ---- --------------- DATE----------------- ----------------------------- ----------- -� - BUILDING PERMIT ISSUED-1 =-__-"`-----------------------------._ DATE. - Alterations and/or recommendations:----- --------------------------- --- --------------------------------------------------------•-•------- I�. ------------------------------------------------------ ----------------- -------------------------•------------------------------------------------------------•---------- ---------------------------------- ------- I. - --------------------- n ---�_ . FINAL INSPECTION BY: r Date------------------------------(�._- . ----------------- { SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. ,300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California lodir California Manteca,California Tracy,California I'.d.co. fir .f .