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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _,.�_2 ------------ --- ---------------- ---------- ------ (Complete-in Duplicate) 7 Data Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct an instA the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L CATION L�� # � . ,r .f" '�"__ ` g" -G eho e�y Owner's Name- --------------- ame � P �c�Gx2-, Address �2__ � ------------- --------•--- -•--••--- ------------------------------- �q� f ` Contractor's Nam Installation will serve: Residence Apartment House :❑ ommercial ❑ Trailer Court ❑ Motel [I Other ❑ # Number of living units: -1--_- Number of bedroom __�j Number of baths _/__ Lot size '" Water Sum pp y Public systeem (]—Communitystem❑—Private' Deptrto WateriTable:"" "'ft Character of soil to a depth of 3 feet- Sand ® Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- ------- 1 No ❑ New Construction: Yes)R�--No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) .wr,. Septi Tank: Distance from nearest well ._:--.Distance from fou ciation_10_______-M�aterial,. ._-_....___..______ ___ ---- ___ No. of compartments -I----- , > P n P � _ .___.Ca skit y_46 Liqu•d dptr Dispo al Field: Distance from nearre�st well.:".-.:. Distance from foundation-..l at-----..Distance to nearest-lot line____... ..._. Number of lines_�Gr_ .--_ ._�__�.-f�_ Length of each line__. _ --------------- of trench..o �`__ --._` Type of filter materiai& -_rDepth of filter,..material'-_`- --��----..-Total length__...__.____i_____.�_ Q_�______�~ See a Pit: Distance to nearest well----- ..------ Distance fromafoundation--------------------Distance to nearestlot line.-.__._._...__._ N.umber.of pits-,.-'- ,a l iging maaerial_------- - '' -. Size: Diameter.--------. ----------Depth---------------------- ----------- .LL .,, � > ssPool: Distance from nearest well!------_.----_-Distance fr mr fvo n�da,io_n,------ �f=-^�_-L-inmg material____.._s__..___.-.__________________ ❑ Size: Diameter- -- ----- ------- Dept h----•------' --;------------- ......`_Liquid Capa^itY--- -------------- ---------gals. ------------------ ------------- -------------Distance from nearest building_-----___-- ..___--..______.___.._---.- Privy: Distance from nearest well- x r_1Distance to nearest lot line..----- t` ,r r 1 Remodeling and/or repairing {describe): -1----- ---------------------ti.'---------;ti------------------------- ------- ------ -•-------- ----------------------------- f I I ------------- -------------------------------------------= - ------------- -------------- i .. t ------------------------------------- ------------ --------------•- ------------------------ i . ---------------------------------------------------------- ---------- I --------I hereby certify that I have prepared this application and that the work will be done in acco`dance w.ith•Sata.Joaquin County ordinances, Stafe Ia4p, and rules and regul tions of'the San Joaquin Local He h District. [Signe -------- - -- -:--- - # J ....--- tl._t.------ ---- -- -- ----- ------- e , (Plot plan, showing size of lot, location of syste.;vNn relafi to wells, buildings, tc., can be placed on reverse side). �+ } �IFOREPARTMENT USE ONLY APPLICATION ACCEPTED BY c_e',e_ DATE--- :'�_-07 _-Jl�- ---------------- REVIEWEDBY---------------------------------- ----------------------------------- ------ ------------------------------------------- DATE-------------------------------- --------------------------- BUILDINGPERMIT ISSUED-------- ----- ----------------- -----------------------:-------------------------- ---------------- DATE---- -- --------------------------- ------------- Alterationsand/or recommendations:---------- ------------------------------ ----------- -------------------------------------------------------------------- ------------------------------ ----- ----------------------------- . -- --- --------.--- - . --- --- ---------- ------ --- ----- ----- --- -- --------- ---------- ----- --------------------- --- - ---------------------------- I FINAL INSPECTION BY:. . _�.�¢. --- ---------- ---------- - - - Date. .�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California I E.H.9 2M 1.67 Vanguard Press