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--'r------ - ' ..G� f `� 4" APPLICATION FOR SANITATION PERMIT Permit No. .... ...... ------ (Complete in Duplicate) ----------------------------- This permi# Ex fires i Year From Date Issued j. Date Issued -_---__-- •��}_- /, Application is hereby made to the San Joaquin Local Heal}h Disfrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND60CATfON....... ``11 7_ ------- ------. Owner's Name-------- - --- --••-------------•-------•---- -- Address--------------- ----- ••-------- --- • --------- Phone.---------- _------•-----------------••-------------- Contractor's Neme____..._��. }-•� - -----L_-_3 --•- --•.--- ---•------- --- ----- -•--- --------- ...--- Phone - Installation will serve; Residence �parfinenf House ❑ Commercial Number of living units: _ ___. ❑ Trailer Court ❑ Motel ❑ Other [] 9 Number of bedrooms . Number of baths -_� Lot site _._N:F- I Water Su ------•........................ .. Supply: Public system Communify system ❑ Private ❑ Depth to Water Table-�ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Previous Application Made: (If yes,date.........- ❑ Adobe❑ Hardpan ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS; ' No ❑ New Construction: Yes [I No [] FHA/VA: Yes ❑ No E] (No septic tank or.cesspool permitted if public sewer is available within 200 feet.) ��Xan4, � ce from nearest well----- ----- ._Distance from foundation--------------------material.................................................. Sept No. of compartments-------------------------Size-•--------•-----------------• y..... Distance __Liquid dep�h--------I FIFrI � Distance from nearest well----------------Distance from foundation.-------------------Distance to nearest lot line.... Number of lines-----------------------------------Length of each line Width of trench. Type of filter material..._.____-"_______ __Depth of filter material________________ Seepage Pit: Distance Total length-------------•------- •-..:_•-_.. ce to nearest well he---__,Distant fo ndation__/V � :Distance to nearest !of line__= �.-.•- Number of pits___._--_ _-Lining material-___- 3�- s ' size: Diameter-.__-- -i Cesspool: Distance from nearest weft-----------------Distance from foundation_._"______...__.___.Lining material-_______-__-•-___-___..__.- ❑ Size: Diameter-----------------------------------•-Depth----------------------- -•--- ------- ------Li Liquid Capacity gals. Privy: Distance from nearest welt_-------•-------•---_--- q P �"--------------------------- p ______-.___-Distance from nearest building ❑ Distance to nearest lot line-------------•-------__-,- g------•---•---•----•-----•-•---•- Remodeling and/or repairing (describe)___________________________ --------------------- -------- - - e ---- -- - -_:.. -- p e his - p ------•------------•----•-----------------•----------------- 1 hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Sam Joaquin Local Health District- (Signed)................................. - ----------- -- ----- ----- ---------------- ---(Owner and/or Contractor) Br--- --•-•-----••----= ------ - • ---- -••- --- = = ---------------------- -- ••--------{rfle)--•------- ----------------••-------•---�-_....-- .---- (Plot plan, showing size of lot, location o ation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------- DATE.--------1 - I REVIEWED BY__.---------•------------- ' Zo.� _ = BUILDING PERMIT ISSUED. } ;� --•------ DATE — BUILDING and/or recommendations:___ ( r9 DATE - - ---- --- --------- . - .� ✓"- ----•----------- ---------------------•---•_---------- FINAL INSPECTION Date__...-._,�. ----------------------------------- SAN _ ..----•---•-------- ----•- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 11 Stockton,California Lodi,California 144 Sycamore Street 405 West 9th Street " EB 9 RE VIS EC e•59 2M p-61 ATLAS Manteca,California Tracy,California tJ .