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I-Q,R9FHCE USE: -------------------------------------------------------------------- ---------- ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------- --------------------------------------------:----- 41 . (Complete in Duplicate)- _--- -----------------------------------=-----'----------- . This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her described. This application is made in compliance with County Ordinance No. 549. 4 40-7 1v— JOB ADDRESS AND C j0N__1!__ --------- Owner s Name------------------ ------------- - _j------- - ---------- ---- ---------- --------------- 1 L° ---- --- --- ---- Address.,---------------- :7 . ..... - -- ----- - ---------- --------------- ----------- ---- ---------------------------------------------------------- Contractor's Nam "7- ----------- --- ------------------ Installation will serve: Residence Q5—"Ap`artmenf House E] Commercial Ej Trailer Court E] Motel El Other E] -Number of living units: --/--,Number of bedrooms-%S_ N berof baths _i7�_Iklf size --- Wafer Supply: Public system E]. Community system ; riat, 0 Depth to Wa er Table -------- ff. Character of soil to a depth of 3 feet: Sand 0 Gravel [-] Sandy Loam Depth Loam [] Clay E] Adobe E] Hardpan 0 Previous,Applicaf ion Made: (If yes,date............._--.--1.--) No E] New Construction: YesI'll Ri"o No El FHA/VA: Yes ❑ No Ej TYPE-OF INSTALLATION AND SPECIFICATIONS: (Wj_sepiician_k_`or_ce ssp`ooI permitted if pubil sewer is'available_w7elifhiin 200 feet.) Distance from nearest well-", Septic Tan ;- 1) -__Distance from foun ---- _.Material--------- --te-�_ -- ____ No.,of compartments- 'd depth----•%(7_6_.Z <ul 'Size4-- )Q ---------Capacity_ _�p_e%A?. Disposal F' Distance from nearest well& _____ __Disfance from foundation----40---�_.Distance to nearest lot line.....- r_. Number ine------ Nu'mber of lines-----,- --------------- Length of each of Type..of filter maferia ------ 4 r"Iq--Depth of filter. mafe,idl----1-9-- ----Total length-----:------------- 0-W a' foundation_._-._. --------- Seep Seepage Pit Distance to nearest well--------------------------)---Distance from -`..____-----Distance to nearest lot line__-.. ..- ❑ ine------ El I Number of pits----- ---------------Lining maferial----------------- -----Size: Diameter------------------------Depth-- fi---------- Cesspoo' l. Distance from nearest well.............."=.Distance from foundafion_-___-___*----'Y�!.Lining material..______...-------------- ---------- Size: Diameter------------- -------- --------------..Depth------ ----------------------T,_----------------Liquid Capacity-------------------- gals. Distance,from nearest well Privy:' J ----------------- _________________.._________Distance frc;rn nearest building_,-...--._-_......,_________1--__--____.r � Distance to nearest lot line-------------- .................r----------------------------- -------------------------- --------_----------------- Remodeling' paq./or repairing (describe):--------------- I ------------------------------------ ---------------•--------------------------------------- ------------- _._......i_"-._-------- ------------ ------------------------------------ ----------- ------------------- ------ --------------------------------------------- ---------------------------------------------------------- ' I 1- -------------------------------------------------------- -------------------------------------- ----------------------I----------------------------- ------------------------------------------------------------------------- ----------------------i----------------------------------------------------------------- - -------------------------------------- ---------------------------------- ---------------------- -------- I hereby'certify fha+j have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law`, an and regulations of fh' S in Local Health District. Ulf! pwk e Oaqui AID > (Signed---------------- - --- ------- . .... ---- --------------------------------------- Co nfracf or) -------------------------------------------------------- --- ---- ----------- e 4. Ocafio'n of system buildings, efc., can be placed on reverse side). (Plot plan. showing size of lo ------- wil S e fFOk:DEPARTMENT USE ONLY APPLICATION ACCEPTED.BY------ --j --------------- -------------------------------------------- DATE-----/ --- ---------------- - REVIEWED BY---------f-------------t �! I y , y _---------- ---------------------------------------------------------- DATE----------- BUILDING PERMIT ISSUED--------------]--I to ---------- ---------- --------- ------------------------------------•---------------------I ------ ------------------ DATE Alterations and/or J -- - recommendations ---------------- - ------ __ ---- -------------------- -------------------------------------------- ----------------------------------------------------------------------------------------------- - -------------------- ---------------------------------------------------------------- -------------------- -------------- - ------------ ----- ....... -------- ---- -_a 197-7N---- -------------- ---------------------- ------------------ -------------------- ---------- ------- --------- --------------------------------------------------------------*---------------*------------------------- _3 q-- - ---------- --------------------------- ------------------------ --------- ---------- -7 11---- - ------------------------------------------------------------------•---------------------------- -------- ------------ J FINAL il\IS�P'01 - - - -- - -------------- --- -------- A ------- ----------------------- -_.__.__SAN.JqAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Syc..—.,.S;,-.'et 205 W;,t 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVI6E0'13-59 3M 3-63 F.R.C C.