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IFOROWIAE USE: I + - -. --------------- ------- ------ APPLICATION FOR SANITATION PERMIT Permit No. ._1-3:d.3.S �. , E {Complete�inDuplicate) � � 4.� 4 . < ^ r' _ Date Issued ---------------------------------------------------------_ ti, This,Permit Expires 1°-Year Fram Date Issued Application is hereby made to the San�Joaquin-,Local Health Dist.ricf For a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No, 549" JOB ADDRESS AND LOCATION---__ _ _.-- ___ _ ��- - ., ;-__- -------------"' .../_.... ____ Owner's Name---- ------ ----------- „ =- -------------- Phone: . Addressr ' •-•• t Contractor's Name -. ' ��!:-�--- ---•- = �' !l`: =_ ,Phonee4 ._7 Installation will serve: Residenc Apa merit House'❑' Commercial ❑ Trait r Court ❑ Motel iOther ❑ Number of living units: .____ Number of bedrooms _f___ Number of baths __/_. Lot size ___=�' a._ _:______ { .rte---u•=••�«n i fy s s fet' � . ,wr .g' Wa+er, Supply: Public sem ' Community system ❑ PriVe[]"`Depth to llVat�"er•-Table _..__"eft. ^^� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay dobtHardpan ❑ Previous Application Made: (If yes,date--------------------) NggW New Construction: Yes NoT' FHA/VA: Yes ❑ % N0,1RI' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank:or cesspool permitted.if public sewer is available within 200 feet.) I - Septic Tank: Distance from nearest well-________-__.___Distance from foundation--------------------Material------------------------------------------------- NO. ___-__ ______________________________________No: of compartments--------------------------Size_--:;�., ------------ ------._.!_Liquid depth------------"------------ Capacity----------- -------- Disposa Field: Diefance from nearest well'----------------Distance from foundation..........----------Distance to nearest lot line.______..___..... I 'N Number of lines-----------------------------------Length of e.-Mine*---_A--------------------Width of tren'h-- -----------.------------ it Type of filter material________________________Depth of filter mater.i_a1____-_-----------------Total length___,_______________________--------------- S _____________ SeepaPit: Distance to nearest well_.--Distance from f undation __ _-__--...Distance to nearest lot line____ 5r_f.._ ! Number of pits--------!------------Lining material-,7W-'t_ _____Size: Diameter------9?.........Depth...... Cesspool: Distance from nearest well-----------------Distance from foundation--------------.---- Lining material__.______________________________.___. ❑ Size: Diameter r----- ----- ------Depth-------------------,---------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____________________________---------------------Distance from nearest building___--------------------------------------- Distance to nearest lot-line.--------••-----------------------------------------------------------•-•--------------------------� ------------------------------------ Remode ing or r pairing {describe)[:---- ------- -- -- --/- .� � r ----- --------- ---------------- -- -----------------------------••------•------•-------------------------------------------------.--------•--------------------------------------- I I hereby certify +ga+-1=have-prepared=+his-application-a d-tha+-+ -work-will,be=done-inraccordance-with San Joaquin County ordinances State laws and rule nd a ulations # the S r�Joaq rt�Local Health Di riot. f � _sem` l' Owner a d or Contractor (Signed)•--- ---- -- --- .-- -- - - - ��- --- ---- - M1�� - ------------------------- '{ � 1 -- ----------------- 1 [Title �ie (Plot plan, in ze o I I y A g c p titin of s em in relation to wells, buildin s, etc., can be la don reversg* FOR DEPARTMENT USE ONLYit - APPLICATION,ACCEPTED,BY--- --• --------------I... DAT : -/ 21, REVIEWEDBY -'----------- "" -- ----=- --- '---- ----------------------------------- DATE ��--------- ----------------------------•-•-- -- f[ -- -- --------------- -- S1--- 4 BUILDING PERMIT ISSUED--=- �--------------------•---------------------------- DATE.----------------------------------------- ----••----------• t e'nr� -- Alteratianstiand/or recommendations--------------•-------------------------=----„------•----------------------------------------•-----••-------------...�..�,�.�-===__------------------------- -------------- ---•-•---•---------•--•------------ ---'---------- ”-e-1- • -- - -- ----- ------ ---------------- --------------------------- --•----------------------------y — �=r �-••- ------------------------ '" �--------- -------------•--------------------•• ........... ------._....._..------------•--- ..-Y.=.,, 'J ---------- ----• _ ------ ------------------------------------ ---------- -------------------------------•--- -------------------------------e -------------------------------------------------------------------------------------------------.--•-------------------------------------------•---------------------------------------- FINAL INSPECTION -- ------- - Date----... ------------ ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore street 205 West 91h Street Stockton,C01iforela Lodi,California Manteca,California Tracy,California EG-9 REVISED 13.69 F.P.r C.2M 6-60