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YUKOFFICE USE- ------------------------------------------ ------------- --------------------------------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) E ---------------------- --=--------------------------- S. This Permit Ex 'fres 1 Year From Date Issued Date Issued Application is hereby rrlade,fo.the San Joaquin,Local Heal}h District {ora ermit to construct and install the work herein described. This application is made incompliance wv tfK,'Cou�ty Ordinance No. 549.1.;-,V L`f q JOB ADDR°ESSAIVD'LOCA ON" -' :BA3/ � � Owner's Name_ _ __Lfs_ ____ ,�y �,1 // /�7a° .� + rl!1 (T' 13;.�/��tr �`_ ------------ Phone_0 - � "t " IX Address--- - A4,�L ='z� �1 1 -----------•• -------------- i Contractor's Name_-- -- -�- - "--- _ Q.M �,�r� /__ ?l � 5J�--- Phone.�__k_V3�_ _ ,I --,� -- - - --- - >l -�'1--- �---tea ." -- Installation will serve: :Reside ce Apartment House❑ ' Commercial ❑ Trailer Court E] El Other Number of living units: .____ Number of bedroos _!oNumber of baths x19 Lot sizeX -_-_-____ ------------ Water. _ _ ? """" Water. SuPP!Y� Publics stem ❑ Community sys ❑ Privateetpth to Water Tabl�____ ft. 5 Character of soil to.a depth of 3 feet: Sand Gravel [I Sandy Loam Clay Loam3❑ lay ❑ Adobe❑ Hardpan ❑ Previous Application Made: -(If yes,date............. --------) .'No New Construction: Yes No ❑ FHA/VA: Yes [] No [; TYPE.-OF INSTALLATION AND-SPECIFICATIONS: ' (No-septic tank:or cesspool permitted'if public a er is aa11a61e.withinr200 feet.). ./ r / > �, Septic nk: Distance`fropm<nearest well " _ _"""":Distance�o foundati\In;�,�.0___-------Material 1V fy,t'_ " a. No. of com artments yr Size_ 4 quid depth__.___. s aF Capacity Dispos field: Distance Oram nearest well I! Distance from founds#ion - '- - __Distance to nearest lot line--------- - �--------------Number of lines__-.__�E" .- _ =Length off, each line____ / 1 / --.Wii"#th'�of trench_._.• -__-- wType of;fil#er material 1 ,pOA f�----------Total 'length ---- ----- VV a•� 1[�_ ." Depth of filter material _ > ' Seepage Pit: Distance to nearest Well---------------------- from'foundation---------__--------.Distance to nearest lot line_. ________"._ r� ❑ Number of pits - Lining material ----------Sizq Diameter.-•- -----Depth---------- ----- LNI Cesspool: Distance from nearest well___________._":_Distance from foundation# r_ i ------ .Lining material-------------- -- --=-- ----------- Size: Privy-' DstanDce f otmr nearest well_ - Depth - Liquid Capacity------------------ ----gals. i ___________________._"____._Distance^,from nearesf,buildin a+ , f3 --------------------------I ❑ Distance to nearest lot line-."......ter..__ - ---------•-- ---------- Remodeling and/or repairing (describe):__._____------------------------ � , :. �Q i I ___________________ --------------------------------------___"___------------_ _____ `�. , __ k_____________ • -• -_____ _____________-_."______________"._________________.__F_____._ __..____________________._______._______-________.__"__.___-_____________________."___ __".._. 4 - ________________________________.____________________________--________________ -_ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, StatiP 1 ws, d rules and regulations of the aquin Local Health District, r I (Signed) -•--- -' '------ : --- Contractor) -----------------------------------------------. ;---------------------- -(Title) -------------------- caner and/or - - - (Plot plan,'showing i of lot, location of system inn�ela4ion to wels;buildings, e` �"tc ean'be placed'on-reverse-side)�•�_ --�-�� .s•f ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEb BY-_ `` t =='-------' - =_ - DATEREV f -------- IEWEDBY------------------ -----------------'----------- ----------------------- -----------------------------------------f----------DATE} . BUILDING PERMIT ISSUED----------------- ------------=-------=----- •--------------------#-------. DATE--------------------------- ' ' mt , Aterations and/or recommendations:-"._________ -` ----------------------------------------------------- ---------•---------- --- `----- ---- ' �J FINAL INSPECTIC7T�1`-8 -� ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California v Tracy,California 1 E5 9 REVISED 8-S9 3M 3-'63 F.p,CD. - -