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FOR OFFICE USE: --------------------------------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --_fy.._.Z-- -------------------------- ------------------------------ (Complete in Duplicate) __________________________________________ This Permit Expires 1 Year From Date Issued Date Issued ----!�/, -7 d Application is hereby made to the San Joaquin Local Health District for a permit to construct and in all the work herein described. This application is made in compliance with County Ordinance No. 549. 26��. "Iu -1� U JOB ADDRESS AND LOCATION------------------------ ____ Owner's Name-----------•---sU__..- -.4,�-•r_,, le � Phone.l/CE___`��3� Address----------------------------------- - G. .- ��/ // ...........fed' a-�----------------------------------------------------------- Contractor's Name------------ •-------------•-- G.l...T---------- -•---_-------•-------•--- Phone..................--•-------.------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer-41111111111110•j$ Motel ❑ Other ❑ Number of living units: ../.- Number of bedrooms ._a_ Number of baths -------- Lot size ------- ------ �_____________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff Hardpan ❑ Previous Application Made: (if yes,date------- -------) Noji� New Construction: Yes ❑ No JF] FHA/VA: Yes ❑ No ER TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tib Tank: Distance from nearest well____�$_4_Distance from foundation____________________Materia_ i :____--____. No. of compartments-------------/----------Size--------i�_ '- -- Liquid depth-----------y_..__------Capacity---_____-ka pis sal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line________.________ s Number of lines_____________________r____ _____Length of each line_________' -0..y. .._._.__.Width of trench___.____ �_j.________-_--_ Type of filter material_.._.e aC_ .Depth of filter material____/____4.1_ .'Total length------------- r#_______._____-___._ See age Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__--___.___-___-• ❑ Number of pits----------------------Lining material--.--------------------Size. Diameter------- --.-Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__._____.--._________----------------- ❑ Size: Diameter--------------------------------------Depth-----------------------•----------------------------Liquid Capacity-------------------------...gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lotline-------------------------------------- -------------- ----------------- � ----------_---'-------------_-_-�---P---�-s-�-----4----_---�S-----..-r--,-S---_-_-- -------- _ Q�.tz�_!,�r� 76- Re deling and/or repairing (describe):__�M -� � . .._ r _____ _ A*W-- A--ja-Je-1.u� ---- -1s rag- � P r L,fs d-A Ale-_A1-- 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 rules and regulations of the San Joaquin Local Health District. r •----- ------------------ (Signedr ) --- (Owner 4wd�or-GaR}raef0lj By:-----------------------------------------------------------------------------------------------------------------------------------(Title)--------------------------------------------- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ _._ __ ___ DATE_____ I$_ __. ------------------------- REVIEWEDBY------------------------------------------------ ------------------------------------------------------------------------- DATE---------------- ------------------------------------- --- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recomm nd tions'------------------- ------------------------------------------------------------------------•-••----------- -------------------------------- ------------- ��--- --- �;�K--=�--- �.. e w_ _a_ - ----------------------- ., - ' - 1. .............. . ..... ......_..---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:------------------------------------------ --------------------- Date------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Es-s FEVIsEO a-ss r.P.=2M 6.50