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FOR OFFICE USE: 7 Permit No. --�•----••-•-�- A 4 ----------------------------- 0a------ APPLICATION FOR SANITATION PERMIT a �' 4 t `� _`'._ (Complefe in Du licafe ...... --- _r P y. Date Issued _ _ ', This Permit Expires 1 Year From Date Issued Application is hereby made to the SanlJoaquiii�Local Health.District for a permit tp cc;n&uct anid Inst 11 the work 'scribe . Thcs application i made in comp'ance with County Ordinance No. 542,4 sl,La � �" --------------- JOB ADDRESS AND LOCATION 1 E !/C = Phone .z�. -----• --- •---- Owner's Name----C��' ------ ----- - 'S ® ----- ----------- Address--------- I`� ;�`�--_-------G '= �� ---- --------- Phone �----- �7 Contractor's Name------- .: . ----------------------------------------- ------- - --- ---- Installation will serve: Residence E] Apartment House [I Commercial Trailer?Court El Motel El Other [I Lot size-------- e/�' Number of living units: -------- Number.of,bedrooms -------- Number of baths - _ Water Supply: Public system ❑ [I Community system Private Depth to Water.TableQ ft. t ❑ y Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑Ej FH dobe Yes ❑ No Previous Application Made: 11f yes,dote.__.---.-_.--------) No [ New Construction:-Yes = No TYPE OF INSTALLATION AND SPECIFICATIONS: k Q\ '- )No septic tank or cesspool permitted if public sewer is available within 200 feet:) _I Septic Tank: Distance from neares} well_ -D. Distance fromM�a/ ----------- p '��:_ le � ------------Ca acit �fs�-�' -.9_ � l Lo of compartments ------------------------- V depth---_.T- - p Y z_ , Disposal Field: Distance from nearest well_ - -`-_-.:Distance from foundationDistance to nearest lot Number of lines_.......... .-'___..I— 'Lengfh,of;each-line-'"` of trench--------•- Y `� I p material_ / ..... otal .length---------------•-=-•---------------- TypEe-of filter well__lf --f----Distance fro �� ' T e,of filter material-___.-_ '__ -De th of.filter foundation____" _ r.---_--Distance to nearest lot line__._-.________, Seep ge Pit: Distance to nearest , - �.S h •s 4':Number of pits- �----,---Lining materials- _ ��..Size: Diamefier.___•_- .--------Depfih_--------- -- -•----------- � G ---------- Cesspool: Distance-from nearest well_________________Distance fto 'foundation.-..- ': Lining material___--..______-_-___-_____.--____-._ -Depth---'� ----- ,- i �� Liquid CapacitY----------------- -gals. ❑ Size: Diameter ------- ------ --- 1 Privy: Di}tante from nearest we41.--------------------°--'T" -►-----=---1-_----Diss;Ince.fromanearesf building---------------------------------------- (d r❑ Distance to"nearest lot line-- { --- -- -. --- ----- ----------- Remodeli g and/or repairing (d scriUe):_ .--_ --- *».: .. --------- ------------•------------------------- --------- --------=--- = = I - • ---------------- ------------------------- - t' ----- ' R. € e* {.: r i _•' = .. ---------------------------------- ------------------------1 ----------------- --- - ------- ------------ ------- f I hereby certify that i 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 San Joaquin Local Health District. - f t -4 . �- I (O ner and/or.Contractor) (Signed) = = 5, , BY� --------------------------- - t+(Pio+ plan, showing size of lat, loationm in relation to wells,_buildings,,etc.,,can,be placed on reverse side). . t FOR DEPARTMENT USE ONLYt. i APPLICATION ACCEPTED BY_.-___ _- -- - ----------- ------------ DATE --------- -- - --- - REVIEWEDBY--------------------------------------------------- ------------- ------------------------------------------ ------ ------ DATE . f. .: . .- I DATE--------------- .-------------- BUILDING PERMIT ISSUED------------------------------------------ ------- ------------------- - .... __/4 1 _ G Alterations and/or recommendat ___-__------ --------=- ------------ ions: rte.--- 2y- =a '(- _ pFS -------' - f------------------�-------- - - ._ __ __ ------- ----••1---------•--- --r------- --�--�----------�--- -- ---------- ------------ ----------- ---------- "--------- --------------- Date---- --- 'Date---- ---- - `--- ----- FINAL INSPECTION BY:--- `------------------------------------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT —_ 300 West Oak Streets f v-k;t y*,�j -%,1124 Sycamore-Stieet 205 West 9th Street -1601.E.Hazelton Ave.�,,,�,,,,,_,.,,,,. ,-- � - - i -..a . y —4 Lodi,California Manteca,California Tracy,California Stockton,California ES 9 REVIBEP B-59 31A 3-'63 F.P.CO. 1