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FOR OFFICE USE: ------------------------------------------------------- -- ----- --------- APPLICATION FOR SANITATION PERMIT Permit No. -/.c ------------------------------------- ------ - (Complefe•in.Duplicate) Dat e*I€sued/_ = - _ Expires._ This Permit Ex fires 1 Year From 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 application is made in compliance With County Ordinance No. 549. L�(O JOB ADDRESS AND LOCATIO -- ---L �lpLg__. ••_,I��-*�- ;__ _ f ------- Owner's N me----- ------ - -f------- ------- Phone------------------ --------------- Address..... • •-- = "'� - "I Contract0 ' Name--- _--- - ---- ---------._-- Phone n., Installation will serve: Residence Apartment House El' Commercial E] Trailer Court ❑ Motel'❑ Other E]40 Number of living units: _. __ __ mber of bedrooms _ Number of baths -------- Lot size --- - -s.________________ Water Supply: Public system ❑` Corl munity system- [I 'PrivateA_Depth to Water Table ...... _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ "Sandy Loam Clay Loam p Clay E] Adobe C] Hardpan ❑ -Previous-�A-pplication-Made:-,{If yes,-date--.- .-.'.)-No [E]a-New-Construction-i=Yesk- (No -No E] -FHA/VA:-Yes �.�No��..,r� TYPE OF INSTALLATION AND SPECIFICATIONS:septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearestwell-_/00----Distance from foundation....J6......... -Material __. 'one -E XNo. of compartments- --=---- --- --...Size--------------------- -----------Liuid depth -- Capacity-��------------- - D�----� Disposal Field: Distance from nearest well. �.C7_._._'Distance from foundation'45---------.Distance to nearest lot Iine�04"1-__- r Number of'lines __.,_= Length of each line__. Width of trench___. f ❑_ -------------- ------- g ��7 \l Type �. --- Depth of filter material-----/------------------Total length----------------------- --------- ,,Se e t: Distance toenear stlwlelL_-_oo-------Distance f 1(u ion/0-0........_. i@st nce to nearest lot.iine __. -____.- FQ fly {dumber of pits:_ _..__._.__Lining material-- - -_ e,:,Dia er.__LY- ---Depth_/-ca� ___. .__.._.___ essp I: Distance from nearest veli ................Distance tom faion....._ material-_...._.___.______.____..___.-.-.�',• Q Size: Diameter. 1_.__J- ----.D th--------------- ---------------Lid Catacit a1s.9. Privy: Distance from nearest well.; .._. ............................Distance from nearest;Building---_---.--------.------------------------ ; ❑ Distance to nearest lot line:-----I�.... ---------------------------------------------------------------r, ------------------------•---------------------- -r'_ 4 - Remodeling and/or repairing (describe):----_.._ 1�].l�[ `jae4 -- j-` ------- Ve-- '"t--{ .......i---•------------------------ ' ` i ------- ------------------------------------------------------------------------- ------------•---------------------------------- - -- ------------ -----=-------------------------------------------------------------------- -------------------------------------------- I hereby certify that I have prepared this application�ndTthat-the work will.be-done-its acco;da^ce with San Joaquin County, ordinances, State laws, and rules and regulations of the San Jo inLocal Health District. (Si ned - c - `"_ '` �" -- r Contractor) g )-=---- _.: - ------ - - --- - --- - - -------- ------ -- Plot Ian showi^ size of lot location of system to tela to wells buildin s etc. can be laced J , gY _ --- _ (Title) .. ----- - ------- ( P 9 Y 9 , p o everse side). ' FOR DOARTMENT USE ONLY APPLICATION ACCEPTED BY.-------t -T-R1 Z-------------- ------------------------------------------------ DATE-- - ----w----------------. REVIEWEDBY------------------------------------------- ------------------- --------------------------------------------------- ------ DATE------------------------------ BUILDING -- ------ BUILDING PERMIT ISSUED-------- -- ----------------------------------------------------------------- ---- ------------------ --------------- DATE-------------------------- Alterations and/or recommendations:----- ----'-------------------- ............ ----------------------------------------------•------------------------- ------•-----------------------' ----- ------------------------------------------------------------------ ----- ---------------•- ------------------------------I-------------------------- --------- -------------•-- --'----------------- ---- ----------------- - -'-'--.. ----- F€NAL INSPECT€O.LLBYDate_. /.. --------- '-� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street '� 124 Sycamore Street 20.5 West 9th Street Stockton,California Lad!, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press