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FOR OFFICE USE: a. 1 , op, . /---; APPLICATION FOR SANITATION PERMIT Permit No. ..- --(,- - -(_- �_v'j_ -----------------�,�3Q- [Complete in Duplicate) 'Date Issue _-_-ky '" This'Permit Expires 1 Year From 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 .ax• QCT _. �y JOB ADDRESS AND OCATI N -- -------- -- ------------------ = th�,t j ,, Owner's Name------------ -L-S ----: --- Phone . :. Address--------------------- _.. . ---- -------- ... Con'tractor's' Name---- ------- = Phone _ -. - ; sr Installation will serve: Residence E].' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ` Number of living units: --------- Number-of,bedrooms -__,_._;,Number of baths ____-_.. Lot size -----/e "a~---------- y Water Supply: Public system Community system ❑ Private ❑ Depth to Wafer Tables ft. Character of soil to a depth of 3 feet: Sand.❑' Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobes' Hardpan ❑ Previous Application Made: [Ifyes,d&6':-- .:._.` _ .'___._.) No New Construction: Yes E] No ❑ FHA/VA: Yes ❑ No F] TYPE OF INSTALLATION>AND SPECIFICATIONS:' 4 , (No septic tank°or cesspool-permitted i public sewer is available within 200 feet.) Septic Tank: Distance from nearest well --_ - ___ Distance from foundation_- -_Q___-__--Mate�al__ _ ----+�_-_4if _.-_/_J_.. _ Ca lJ _ f� � �i - is-_,g-�------------•._Size��-i��iquid depth- _!-�-�------------ - P � P Dis osal Field: Dotance f opmrtearest well7;?A^t..Distanice from foundation./fl----------Distance to nearest lot line_,.7------ - �,Number,of Fines._---`-�-------- --------- -Length of each line-----------��ei---.Width of trench_--.�-�il_- 10--------f---- = i Type�of.filter materialSi_ �trDepth�f filter material___ '?---------- length-------_Z"��.____►��_:______ Seepa e Pit: Distance.-to nearest well.J -----Distance from flu ndation__,,�_Qw�_._"Dista re to nearest lot Number of pits.-.-_/-------------Lining material -.-Size: Diameter._-.;�g---- ----Depth------R.5------------------- 'p Cesspool: Distance fr6M nearest well-----------------Distance from foundation-----------.--------Lining material__._______________.__________-__.___ + ❑ Size, DiBmefer---- ---I----------------Depth---------------------------------- -----------------Liquid Capacity- ._gals. 1 'Privy:. Distance--from.nearest wel---"------____.__ ----------------------Distance from nearest building ----- El Distarice to nearest lot line----------------------------•---------- i ---- --- - --- Remodeling and/or repairing (describe= tl� --------------- -----------•-------- --------------'------------- -----------•------- ------------------ -------------------------------- --------•---- --------------------------------------------------- ---------------9s, ta --------------=------------------------.-----------------------------------------------------------------------------------------------------------------•------------------------ ------ I heify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinanclaws, end rules a gulations of the San Joaquin Local Health District. 17ti�(Signed) -- •-- -- - ------ -------------- fation ------- -,-- -----------�- - ----------- caner and/or Contractor) i _ � BY:--- -- - `-'-`Title)--i-- , (Plot plan, showing size of lot, location of system in re to wells, buildin s etc., can beiplaced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------At ----------- t - _-=-•-------------------------------- DATE-------Com' `- , `% --------------------- REVIEWED ----- -- - -REVIEWED BY-------------------------------------------------------- ---------• -----------------------------------------------------•-- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED--------- --------------------------------------- ------------—---------------�-f:----------------t DATE.---------------------- Alterations and/or recommendations:--__...__ _. 17�-- — �'�'y =`— ------ ` -------•--- --- -------- --------------------------- >_--------- ------------- - - ----- ` / 7 L ' c r` c'— 2�.�------•`-• - �~ JG------ ----- t �t `rte (_ �-- - - - ------------ ----.- -------------------------------- --------------- ------------- ----- --------------------------------- ------------ F1NAL INSPECTION BY-- - ----- Date------- �:/-..1�- -• --- -------------------Y---- - - ------ l SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Are. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California N ES 9 REV15E0 8-59 3M 3-'63 F.P.CO. ,