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FO)z OFFICE USE: # -( ------------------ & X ----------------- & �----------------�_L3-Q APPLICATION FOR SANITATION PERMIT Permit No_/_7__... & -0: (Complete in Duplicate). ------ This Permit Expires 1 Year From Date Issued Date-Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct'and install the work herein described. This application is made. in compliancW4- -1 ith County Ordinance No. 549. JOB ADDRESS AND LO ATION..:. S ------ 2Owner's Name---- - --(�"-----ti--�:_!(�_ _v -" - -- - ------------------------------ .Owne --------------•---- ------------------- Phone -------------------- Address = -------------------------------------------------------------- /yt C Contractor's Name-- 16 Q _1'----------- --------------------------------- --------------------- Phone------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ { Number of living.units: Number of bedrooms Number of baths+ Lot size 4 z_ � _ ____. _______________ _�_ �/ Water Supply: Public system ❑ Community system Priva+e ❑ depth to Water Table ( _ ft. i Character of soil to a depth of 3 feet':1. Sand ❑ Gravel ❑ San oam ❑ Clay Loam ❑ Clay ❑ Adobe Previous ❑ Previous Application Made: (if yes da-te._______.__.___-__) No New Construction: Yes ©�No ❑ FMA/VA: Yes [ IQo ❑, TYPE OF INSTALLATION AND SPECIFICATIONS: . " No septic tank,or cess ool_ ermit+ed:.if_ .Liblic_sew.er_is_available_w.ithin-200_feet.) Septic Distance from nearest weli__%5_0------Distance from f �at/erial_ �C: E7 No, of compartments__.- ______----------Size_. , - Q--Liquid depths__.-1--�,-"-._------ Capacity____/- -- 1} I # foundation � Dis oral ield: Distance from nearest well_..,�_�_-Distance from -__,/..A__--_____Distance to nearest lot line____ __l.___ QL i Number of lines- ______ _:_f___-�f-______.__Length of each line_____. .D ��___"" Widti' of trench-_-1 _. _______._-""--_.-__ F , Type..of filter.material---j� ___Y_-AGJCbepth of filter material-.___ -----------Total lerigthl___/.f ------ - See pa it: Distance to nearest well__A� � Distance from foundation----1_�__1_-__.Distance' to nearest lot line_-- Number of pits___. - Linin rnaterlal_Y,51 _ Size: Diameter__ fi Cesspool: Distance from ne�e5f well------------------Distance from foundation:-,___._._____`------Lining material_____________________ l w._ _ _ ------------- ❑ Size: Diameter- De.pth.- ---------------------- Liquid Capacity--------------- ----gals. Privy: _ Distance from nearest well �° "' --_ -Distance from nearest buildin 1 ------- - ------------ -- E �. . ^� ---- ! Distance to nearest lot line ------------------------------ ------------------------- ----------- ------------------------ ❑ r, =' ---- --------- ------ Remodeling and/or repairing (describe)c__.____________ y- �� 9 S-d-' e--- v>� ------------------- -------------------------•---------^--•-------- I:. ------------------_______________�_---------- • l t I`hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, d rules a regulations of the San Joaquin Local Health District. (Signed)----------------I-=--- ' _ T ; .r (Owner and/or Contractor) _._________-""f-" F ------------------------------------- (Plot --------------------_ t - _ Y� - Q------ {Title} --- - ..._ (Plot plan, showing size of lot, locati n f system in relation to, ells buildings, etc., can be placed on reverse'side). } FOR.-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._.- ---" ------ q- — ---------------------------------- ---•-------- - ------------ DATE- --- REVIEWEDBY--------------------------------------- ----- ------------------------ -------------------------- ------ DATE BUILDING PERMIT ISSUED------------- - ---------- Alterations and/or.recom7_ nda+io,ns•_ss-____. % // �y). �� ,r � ��------- ----------- ------------------------------------ ------ ------------ ----------- -------------------------- w-- _ . . FINAL INSPECTION BY: ------ ---- ------ - Date �' Z�- S N JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazehon Ave. '.'3 West Oak'Stree f 124.Syeomore Street R` t f 205 West 9th 3treeh t ' ' _ Stockton,California Lodi,California M anteca;-California —`-' Tracy;Celiforriia ES 9 REVISED 9-59 3M 3-'63 F.P.E d.