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F , 6 �3�sa3O OFFICE USE: s� ----------------- ------- Permit No. .. �y� J APPLICATION FOR SANITATION PERMIT 11 rr ` i`q (Complete in Duplicate) J 4 70? � �� Date Issued --!6�Z"3,� 3 _- This Permit Expires 1 Year From Date Issued --- cat -- y - with Count Ordinance o. for Application is hereby made to the San Joaquin Local Health District fora permit to constructland install the work herein described. This application is made in compliance wi y �) �9 --•------------ JOB ADDRESS AND LO �0 '�`- - ------ ---- ------------ -- /} � ~� - _:------- ---- L� �7�7,8 �S`l _ �! Phone _ e� •,.F Owners Name------------- -• •--- -------- - ------------------ Addrass - ---•----- --•^- �� .MW---- Phone. Contractor's Narne_� -- ---- •-- ��------ -`-`-'�--�--'- ------ ��--_..---al----- Mo#el Other ❑ Installation will serve: Residence partment Ho e ❑ Commercial ❑ Trailer Courll ❑ ❑ Number of living units: _�_-_ Number of bedrooms= Number of baths -_ - Lot size ---- ---- ------ #h to Water Table ft. Water Supply: Public system ElCommunity system ❑ Private Dep 11 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ardpan ❑ ,i �V Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑j NoFHA/VA: Yes ❑ No ❑ , I' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permitted if public sewer is available within 200 fee#.I j �ic�Tagk:� Distance from nearest wall_____.__.--_____Distance from foundation_________________'_.Material__..._-____-.---__---_---------------.----------- I No. of compartments----------- --- -------Size-------•------------------- Liquid depth Capacity �J ��"' Distance to nearest lot line__,P ___- I m3alild: Distance from nearest wel �___-_..._.Distance from foundation__ iF L II Width of trench____ _zL-----------=-------- �1� :dd�'r'�jl Number of lines -•--- - ---- Length of each {ine (1 Type of filter material� r ---Depth of filter.material__ .--,� __ Total length___-. =---, ---- r I S pag dt: Distance to nearest well l` _____.-___:Distance om foundation-____---RO__bistance to nearest lot line__- �--.- I Depth- -------------- ` Size: Diameter__._ - x �Number of pits-----'1'------- Loring material - p Ces pool: Distance from nearest well_________________Distance from lo-u--n-d- afion...____________��__.Lini id material_-._-___._.-___.____.________-.._.._.. ❑ Size: Diameter Dep}h -------------- Liquid Capacity - gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El ------------------- -------- ❑ Distance to nearest lot line--------- --------- ------- ------------------------- i------------- `----------- ---------------------------- Remodeling --------- ----------------- II i� -------------------------- Remodeling and/or repairing (describe):-- -- ------- ------ ------------------- - ------------------------- --------------------------- -- - ------------------------------------------------- --------•------ - 3 p Pp - f hereby certify tat-1-have prepared this application and that the work wll be done il ___________________________________________________ ty - ---------------------- -------------- - ----- - - _ ----__ - p n accordance with San Joaquin oun y Y Y ordinances, S# a sran rules an- gulatlons of the San Joaquin Local Health District! 1 - J'� _ r-� !I ( w"edc'r-Contractor) - i =-- (Signed)-- -------------- I: ' ---------------------------------------------- ------------------------------ ----- (Ti#Is� Y•-- (Plot plan, showing size of lot, location of system in relation wells, building , etc., can be; placed on reverse side). FOR DEPARTMENT USE ONLY I! --� APPLICATION ACCEPTED BY___- �/------ -- � \ ---------------------------------------- DATE-- /K ATE__ rte/ REVIEWEDBY---------------------- ----------------/---- ------ ------------------------------°--- -----------,-----------------.- - DATE tDATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------- ---------------------- ----�--------- ,�-Z` Alterations and/or recommendations:______________ tom---�� -`--------- ----------- P `E` `'- {L' �Y f`4 ------------- -------- ----- ----------------------------------------------------- ---------- ------------------- --------- J---. --------- ----------------- - FINAL INSPECTION BY:-... ---r3OO `� -� ------------ Date-----.. JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. st Oak Street 124 Sycamore Sfreet;I 205 West 91h Street Stockton,California Lodi,California Manteca,California '' Tracy,California ES 9 REVISED 6-59 3M 3•'63 F.P.CO. i, ,