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FOR OFFICE USE: _ --- 3 i ----- - - �- - ---------- --- APPLICATION FOR" SANITATION. PERMIT Permit No. �_._�?'�.--.... ------------------------ o , a ---------------------- ------------- --------- -- � (Complete in Duplicate) ............ This Permit Expires 1 Year From Date lssued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta{I the work herein described. i This application is made in compliance with County Ordinance o, '544. JOB ADDRESS AN�OCTION*�_,�---------41 i 16 - Owner's Name------- Phone. Address-------------------------- - --- ---- ------- ---- --- ---- Contractor's Nart9. s --i fit-r-•----------------------- Phone--��fP_- Z' Installation will serve: Residence Rr-A--partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of livingunits: --- - N ber of bedrooms -- Number of baths _ �__ Lot size ---t�--_-._?'�---,f �:.3 - Water Supply: Public system Community system ❑ Private ❑ Depth to_Water Table _4�9ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe ardpan El Previous Application Made: {{f yes,date--------------------) Na El New Construction; Yes El No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPE61FICATIONS: o septic t k or cesspool permitted if public sewer is available within 200 feet.) Se c Ta Distance from nearest well-----------------Distance from foundation------------------- Material----___-___-----------____----------_-----------. No. of compartmelits------- ---- -------------Size--------------------------- A_Liquid depth--------------------------Capacity----------------------- -------`45istfr Tv' t osal eld: is ante from near est well_______- � foundation--------------------Distance to nearest lot line---------_----. Number of lines---t ---------------I-----------Leng#h of eaeh�i ne--- ---------------------.Width of------- trench----------------------------------- !t s Type of filter mater '� nal-_ � - ne Depth of filter ,Yml______ ateria _ _______________To#al len , length r.- - -�/y P / Seepage Pit: Distance to Weare,t we distance f m foundation----l-__.__`ee_.Distance to nearest lot iin p Lining material----- - _0 ---Size: Diameter--- I- -.--__-- Depth-.ca- ----=--------- - Number of its---- . - _-- :� of Cess❑pool: Distance from nearest well-_------------Distance rom oundation.........-----------Lining material........._-__-_l------._.___-- -_ A Li uid=Ca pacify... - Size: Diameter-------'------------- --------------Depth ++ G P Y - =gals. Privy: Distance from nearest well------=----------------_ --- ---- -.-----Distant from nearest building-. - g-•------------ -------------------------_ V1 ❑ lot line ------ l --------------- Remodeling and/or repairing (descr'L -------------------••--•------------------------------------- -------------- - -------------------------------------- -- ------------------------------------------------------ s ti --- - - I ,hereby erttfy that I have prepeed this application and tha+ +he work will be' done In accordance with San Joaquin County ordinances, a I w�and rul and `eg latio theWJaquiLocal HealtDis+rtc+(Signed " .� �: `'`�` ---------------- tactor) �,.� BY ---------••----------------------------------------------------------------------- (Title)-------------------------------------- .--------------- (Plot plan, showing size of lot, locationl of system in relation to s, buildings, a ., can be placed on reverse side). -i OR DEPARTMENT USE ONLY E APPLICATION ACCEPTED BY----------- r- - �r------------------- u: DATE �� =�i-{j --- ---- -` REVIEWED BY --- -- ----------------------------------- x --------•-•- DATE BUILDING PERMIT ISSUED----- t------------------------------------------------- ------------------------ t DATE------ ---------------------- Alterations and/or reco a tions: — `'* f ; i LL� / i- r - -- --- ------------- -•------- "� 1` -------- 1 ------------ -f ------- r-yv---- ------------------- -------------j-------- - ----------------------------------- f --------------: -------------------------------------- ---------------- -------t-------------- ------------ - - -- ---------------------------------------••-------------- -------------------------- •------- --------------- - -------•-------- ---- - ----------•------- ---------------- ----•-- -----•--------- ---------------- #` --- -----------------•---------- ------ - ---------------------I-------- - - ------------------------------------------------------------ --------- ------------------------------------- ---------------------- FINAL INSPECTION BY: f='-r crrJ ---- -------- k. Date. =�4' —------------------------------------------ 19-1' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.Ca, -- . 7 -