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FOR OFFICE USE: s. A _____ _____________________ --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .___..__.____..___. .___ ------------------------- - ------------------------- (Complete in Duplicate) q --.--- This Permit Expires I Year From Date Issued Date Issued __-f___,-._.. -b Application is hereby made to the San Joaquin Local Health District for a permit to construct d install the work herein described. This application is made in compliance with County Ordinance No. 549- JOB ADDRESS 6ND LO TION--------- ------- - ------ --------- ----- •-------------- ---- Owner's Name- �---- ---- --------- Phone Address---- '`'°� Contractors Name N'Q -------------- -J.� �`-'``` �'e=-' Phone_ .---------4_T Installation will serve: Residence �partment House Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: I--- Number of bedrooms __!__- Number of baths __[--___ Lot size ____7r_4:-- Water Supply: Public system .Community system ❑ Private ❑ Depth to Water Table -------- ft. s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E❑ Clay Loam ❑ Clay ❑ Adobe7&Hardpan [] Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ NoA1_FHA/VA: Yes ❑ o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o se t' € �p�o-I permitted if public sewer is available within 200 feet.) i Tan ., D Mance from nearest well---------- ------Distance from foundation--------_-----------Material_____ _* A. of compartments_______________ 5_ize_, __.-__.,___ ---------Liquid de th--------- - --------------Ca acit al I r li/ Istance from nearest well_ -- Dlstance from foundation..__ Distance to-nearest lot Ilne____:�___ T e of filter materi _ Length pf a h Ilne-__�-.__ ._______ Wldth of trench.=:We,-_-._.- ------------ yyp bei of lines----,-/ri Depth,oi,#Cfer'material____-_r__y-` ---.Total length-________ _______ _ __---------_- Seee Pit: Distance to nearest well_- jr]!�-.__ Distsnce from foundation_-.2-Q______-_.Distance to nearest lot line.... -- _-%_ Number of Its-_ � � p I_________________lining materlal_J �-----Size: Diameter__�_�� Depth_ci c`'______ p 'Lining mafenal -------------- --------- 6 Depth t Cesspool:: Distance from nearest well_________________Distance from foundation___._. ❑ Size: Diameter-____.:= _- --------------------Distance fro---------Ligwd Capacity-- --------------- - �---gals. Privy: Distance from nearest-,w II------------------------_-- -________-- f _Im nearesT`rbuildint-------------------------------- Dlstance to ne3re ti.lot fi*ne ;---------------------------- ------- -- --------------------------- w. r Remodeling and/or repairing (descr--ibe):---_.__--- __ ----------------------- - -� s --•--_ --------------- - -------- --- I __ F _ F.-_ -- -- _______________________ __________ _______________________________________________________________________ ________ __ ------- - - - ------------------------------------I-- - --- _. _ ,rIG -- ----- - I hereby certify that I have p 1 pared this application and Lha# the�work=will be done in accordance with San Joaquin County ordinances, State laws d rules and"regulations of the San Joaquin Local Health District, ------ ---- ---,- - _ {Signed)___ . wn ontractorl Plot Ian, showing size o lot, loca t n of system -- relation to• Ils,-buildin s, � _^ +� BYS5Iw,Mier� ti�$ bf ¢z - -- ( P 9 ff Y g etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------- DAVE *- -- - r REVIEWEDBY------------------------------------------------------- - ------------------------------------- -------------------- DATE BUILDING PERMIT ISSUED---------------------------------- ------------------ - �D�ATE- tm '---------- - � Alterations and/or recommendations:____- rI_•.12._'66------f�i d_ :L-:-- "'� ----------------------------•- •---------------------------- --------------------------- -------------------------------------------------------------- ----------------------------- -•----------------------- ------ ---------- - --------------------- -------- •----------------------------- - -------------------------------------------- ----------------------------- -------------------------------------------------- ----------------- FINAL INSPECTION BY:... wze� Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O. ` }