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j 61110 Urrl : USt , ------------------------ I- JQ---------------------------------- o;. APPLICATION FOR SANITATION PERMIT Permit No. _4ss - ---- ---------- ------------ --------- =-------- .(Complete in Duplicate) This Permit Ex"fres i'Year From Date Issued ---------------------- ------------- - Date Issued __/! r�-- { 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 549Z ------------------- / 1 JOB ADDRESS AND L CA ON__�__� - '--_7..__4=,__ (� Owner's Name-4)_1----•--- ----------------------A46:��--- --------•-------------- `-=- _ � -- ------ _ Address.......... ----------•------------------------- Contractor's NamX /- f ! / Phone----- - •• Installation will serve: `Residence Apartment House ❑ Commercial ❑ Trai�r Court ❑ - Motel ❑ Other ❑ Number of living units: ___ ___ Number of bedrooms /Number of baths ________ Lot size _ 4- --x Wates: Supply: Public system A Community system ❑ Private ❑ Depth to Water Table 'Old ft- s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay,Loam ❑ Clay ❑ Adobe Hardpan ❑ I Previous Application Made: {If yes,da#e___.___._----_---_.) No ❑ New Construction: Yes E] NoHA/VA: Yes ❑ E] ' No TYPE OF INSTALLATION,AND-SPECIFICATIONS: L(No, se nk or cesspool permitted if public sewer is available within 200 feet.) t k: Distance-from nearest well____--___-______Distance from foundation--------------------Material___-_-___-_____-__.___.__-___- -f�J No. of compartments -----------------------Size------------------ =----------Liquid depth------------ --------------Capacity--- l Fposa ePd: Distance from nearest well._ /-_Distance from foundafiion--� A-__-_Distance to nearest lot line____iG�_�___ Number of lines_ _______ _ ___ __ti___ - Length of each line_, Q___-_ ------- Width of trench_- ►y_ `P__--- . - ..�,.Type,of filter material_ --Depth of filter,materiaL__._ _ .�� -.--Total .length__._____c7c__O_!--_-__.'________- *J See pa a Pit: Distance to nearest well.�4� - _ 'Distance ro foundation___ /Q # ---- -_.Dist n e to nearest lot line_ ----------- pits 6 Number of _ :_ __ -_.__.__ Lining material-]____ ,,rrte� -- --- Size: Diameter- - Depth---- c2--`� --- �---------- Cesspool: Distance from nearest well-----____________Distance fro foundation___---____-_---___.Lining material_-_--_-____.__..____-_____________- i 0 Size: Diameter - ------------------------"Depth---:------------------------------------------------Liquid Capacity I- gals. (11�� i Privy: Distancefrom nearest ----well-------------------------- --_ -�_ ____-_-_-_-_-_- ___Distance`from nearest building_-_--_----.----_____--___ El Distance to nearest lot line i --------------------------------------- Rem' deling and/or repaing,[descrihe�:- ---------- F,.... ------------------------- ------------ == -------------------------------- i i _ _ ------------------------- - _ � �; +° a ' :. = •----------- -------- --------------------------- ------------------- = - ---- - -- -- 1 - --------------------------------------------____ I hereby cert- that I have prepared this application and that the work will be done i accordance with San Joaquin County ordinances' Jte fa rules and�regulations of an Joaquin Lo I Health Distric , P �74,;.. - [Signed)--------- [ �t ----------- - -- ---- - ------------ Contractor s B . �. _,___ ) f' (Title) ;�! By: - - - -- (Plot plan, showing-size- of lot, location of system in relation to IIs, buildings., etc can be placed on reverse side). FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....�- ':- s ------------- DATE----I_1--`__t_� - 1a- REVII WED BY--' ----- - ----I-------------------_ ------- - -------------------------------------------- DATE---------------------------------------------------------- ---------------------- PERMIT ISSUED_ ' ---s�-•----- DATE Alterations and/or recommendations:--)- �'--�-'-�.a� ] lxl ---p 1----- �''8-cd"q- ll �S ------------------------------ ------- ----------------------------- ---------------------------------- - -------------- ------ --------------------------------------------- I ------------------------------------------ --------------------------------------- FINAL INSPECTION BY:.......Lt _t_- Date_...Y {Q ------ } SAN JOAQUIN LOCAL IrIb&H DISTRICT 1". 1601 E.Haxellon Ave. 300 West Oak Street^ '"► 124$ycomore Street , 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVFSED S-59 3M 3-'63 r.P.ca.