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APPLICATION FOR SANITATION PERMIT Permit No: -__ .- - ---_ (Complete in Duplicate) , � . 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 applicationis .made in compliance wifih County Ordinance No. 549. dw � OCATION--- — IV' -------- OwBerAsDNamS� AND'L T _ : - -- --------------------------- r -•-,- _ _ Phone Address =- _ --- r Contractor's Na ,,Phone----------------------------------- me-----'-----�-------------<-- - ----------- - -------------- - -- I ' I Installation will serve': Residence Apartment House-E] Commercial ❑ Trailer Cour} ❑ Motel ❑ Other El Number of living units: ________ Number of bedrooms ________ Number of baths ____.___ Lot size «_____._______ SZA_.t_x-D----------------- i Water Supply:-Public-system 4 Community system ❑,'. Private ❑' Depth to Water Table ________ ft. Character of soil to a'depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Uk Hardpan ❑ Previous Applicatio,)In Made.' Yes I] No E❑ New Construction: Yes ❑ No ❑ FHA'/VA: Yes ❑ No ❑ _ TYPE OF INSTALLATION AND SPECIFICATIONS: i [ ry p 5 pDJ ° �r ) eat.] No septic tank or'cess ool ermitfed ifpublic sewer is available wif6in X200 f Sep is Distance #rorri nearest well__ __ stance from fo�indation____--_1U____-Material--- ---______ __-- -------,- ____--- No..of compartments_ � Size . i Liquid depth--- - --- y --- -Ca acct �`�JC)_ Disposal Field: Distance from nearest wtrell Distance from foundation_._1�________-Disfance to r�earest lot Number of lines---- -------- ---- --- •- f - --- ----Length of each line�._ � _^Z_5_'.Width of tr3nch------- Tylpe of filter material �� epth of filter material _____LS'�_. ____Total lengthl________________w.-��,�' ------ r . --•- g `PitDistato ---------®:_Distance from foundation_______________•_'Distance to nearest !online_____..______.- pits �_._--------------Lnng. m❑ Number of iaterial_____.___ __ _______Size: Diameter__ -_ epth -----=--`----------------- Cesspool: Distance fromnearest wall__ s Distance from foundation--------------------Lining material----------•----- _ -__---=_______--- ❑ Size: Diameter_ _ ___Depths' _______-_Liquid Ca acit �4A ga Privy: Distarlc frorri}rest>weI . ----- Distance from nearest building i _ ❑ Distance to nearest iot-line - _ i `-`""" w Remode€ing anq1/or repairing (des gibe) :- --- -- Z-- [iUO, Q L' . ` i. �pf -------------------------------- - -------.---------------- ---�._-��------•----__.___---------�`---____`_----.__---~--------------- - - - -- •---------'• � '+ = = --- )1------------------------- -------------------------------------------------------------- -€-- - f • --------- x -------- - t------ - ) ! hereby certify that I have prepared this application tend that the work will`be ,done in accordance with San Joaquin County . ordinances, State loans, and rules and reg I tions of the Sa dgaquin Loca'kHealfif Disfirief. . (Signed)_ �r ' - ' � --------------------------- -------------- '�f (Owner and/or Contractor) f ------------- ---•--------- -- ---- --' -------------- '-- -----]Title)------'------- -- (Plot plan, showing Size of lot, location of sysftm in relation-to,wells, buildings, etc., can be placed on reverse side). ,FOR.DEPARTMENT USE QNUY A31i A&hW1 , APPLICATION ACCEPTED BY----- ------- -- ---------- ------------------------ -------------------------- DATE------------- -1I----- �-- ----------- --------------- - , 'REVIEWED BY----------I=--------------- ra ` j- _ .--J-- ------ ---- - ----- -----------I------.-.-.-.-.-.----------------�_----7- ill` - DATE - -- t ---,-------------------- �ji --11-7--�-- - --------------- BUILDING PERMIT ISSUED_____________ ____'_ --- - i --------------------------------------- DATE-- - --- - - ------------- Alter tion and/or recommendations___________________ ___. ___ __ --- ------ - - ------,-- ----------------•• -------- --------- -------------•------ - ---------mac.. ---------_ ----------=-------- ------=--------------=---------- _________________________ ____________ ______ ___ .. T. -----------------_____ lo - - - - - i FINAL -INSPECTION`BY:-- --- ----:- =" _ Date ` r -,7------"---- ____---___ i SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 Wesf Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 4q ES-4-2M Revised 1-57 F.P CO. ' Q5,„