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— VrrlCt UJt: ' t - , ^ ' - -------------- ------------------ ------- - -----_�----- ----------- 1-3d---- APPLICATION FOR SANITATION PERMIT Permit No.- ----------- -0 � ` - ------------------- ------- (Complete in Duplicate) ' --- -----------------'--- ------------------------. This Permit Exi3ires. 1 Year From Date Issued Date •Issued __-- Application is hereby made to the San Joaquin Local Health District for a permi to construct and install the work h in described. I This application is made in compliance with County Ordinance No. 549 - ea JOB ADDRESS AND CATION_ -"j --- ----- - Owner's Name Q_ f -- -- -------------- ------ --- Address--L --------- --------- ----- Phone Address__:--------•-•--------�=---- �_ 4 S - - --------------------------- ------------------------- ---------------------------------------- ------ Contractor's Name-- r �.. _�- -•-- °" Installation will serves'Residence Apartment House ❑ "Commercial } '�'{ ,r. �*. ❑ Trailer Court ❑ Motel ❑ Other �] f Number of living units: ____.-1Number%f bedr&o1ms1_S'�rl_ NurriB"r of baths .-- Lot size . � � Water Supply; Publics stem ------------ Y Communpity system ❑ Pr.ivate K Depth to Water Table sO _ {t. Character of soil to a depf of,,7, feet: nd ❑ Gravel Ell/Sandy Loam ❑ Ge Loam Clay i it Y ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: l:If.yes date __- No New Construction: Yes No I ❑ FHA/VA: Yes ❑ No Ki' *� .� '` TYPE OF INSTALLATION FAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) L�f Septic Tank: Distance from neare"st well________-___-___ Distance from foundation_________ _______ ❑9ff I11rCal o:'of'compartmts--- Material Size- Liquid depth --------Capacity------- --------------- ? Disposal Field: Distance from neare t well S.-Distance from foundation. -�� t ` --�•k----"._.Distance to nearest lot line_.1.. --`• + Nurrib r of line0'_ _____ .....Length of each line__-- it fr of'fil er material___. g 1 Width of french- Type _ - "._--De th of filter material" - I l 1 f f / I Jam` -Tota! length--- ' Depth ----------- Seepage Pit: Distance fo nearest.well.f- -_4_----_Distance&2�k ndation__ !______ tfif. Nmber of pits. ��J� Linin�°g.material__ -.Size: Diame D'sta��e to nearest lot fine--- U.. _ " titer_ 3-3------ -----.Depth_��`-------------- Cesspool: �J 1 ` -y Distance from aesft well `t"" `� r;; Distance from•foundation._-_------- Lining material----___"--_._"-- �r " - F-:��, �' Size: D;ametei-�---r =------- -------- --------De th-------- .« � , p, ---- ------------------------------ Liquid Capacity----------------------------gals. Privy: Distance from nearesf well -- i -----------__-.-_____---:_-_____--Distance from nearest building ire. ❑ �Distance'to neare ' i -� __ __ Remodeling /o(and1re alrm' describe p 9T( , �-`-- , .. ------ - T 'r` --------------- ----------- ------------------------:-, -- ------------------- ---------------------------- I " hereby certify that a prepared this bpplication`and }' # the work will be done in accordance with San Joaquin County ' ordinances, State laws, nd r les and re ulati ns ofjhey$an-V 0in�Local He District. 4 ik (Signed)---------------------- -- --- ------ - - - ------- - ---- ---- --------------------- er and/or Contractor) -. . w g Y ' (Tifle)---- __ _ _ __ Fon to wells, buildings, etc., can be plat on reverse side). Plot Ian, showin size o lot, location of s stem in rely t �- FORD91PARTMENT-USE ONLY f APPLICATION ACCEPTED BY__"------- —A __------------------A' !------------- DATE � REVIEWED BY / �• ..# i_#� �. tr- -------- - ------------- -------------- ------------ DATE------- ---- BUILDING PERMIT ISSUED y -- ----------------------------- ------------ DATE Alterations and/or recommendations:_-' -_--t'; -gs-�, C': 1 / �G� _G ------------- ---------- I �_ ----•------•--------------------------------------------- ----------------------------------------------------- - ,_ ----------------------------- ----------------------- -------------- ------"-------- ---- ------- .40*g -------------- --------------- ------------------ ----- FINAL INSPECTION BY:- ---------- Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT e 601 E.Hazelton Ave. y 300 West Oak Sheet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P,CO. ' F