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FOR OFFICE USE: y------7/.3gz__1&-- --------- ----- APPLICATION FOR .SANITATION PERMIT Permit No. ZZ? --`--------- ---- --------------------- - - -.-----�----- -- .. . _ (Complete in Duplicate). . Date Issued , --------------------------------- --� -.`-" This Permit Expires 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 o. 549. . �, . towoo ADDRESS AND LOCATION-------------- ------------------- ------- -- dj------ -- ,�. t-ti.--�. Owners Name""-"" � ..-�.-,----�* � � wo„Phorie-�� 7"- 1 = Address".. l' S� �-----`------.... . . R. ,Contractor's Name � �•�' � -- ------------ C�'�' e ; Phone��--- - � - - --------------- ----------- N Installation will serve: Reside-nceV Apartment House [] Commercial E] Trailer Court E] Motel ❑. Other E]- Number of living units:.-_-- Number of bedrooms " Number of baths _ .Lot size _""-. -_ ' Cs_- J�-"----__-""-"."""_ Water Supply: Public system' Community system ❑ Private ❑ Depth to'Water Table,�ft- # Character,of soil to a depth of 3 feet: .ySnd ❑ } Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made. (If yes,date `,------ } No ❑ New Construction: Yes ❑ No� FHA/VA: Yes ElNo El *'+ i • TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if.public sewer is available within 200'feet.) W' a'nk: Distance from nearest well_-" ". " Distance from foundation_"-_"""-"---.-- Material------)_.____-.___----.---__ No. of compartments--------------------------Size--------------"J -----------Liquid depth------------------------ .Capacity_ --yy��,,� jr +: Distance from nearest well/� -'Distance from foundation_"" d___---Distance to nearest lot line--�S--_--Number of lines"""""-_--�__.".-."""_ Length,of each line--_.,.. Q" ---��----_-Width of trench-.-.--".Type of filter material_S1_� __Depth of filter material � Total length-------------------------;.?�_______ S t: Distance to nearest well_T e"11.9! "Distance from fou -dation__ :_ ".Distance to nearest lot line_---s---._ L(} Number of pits-------,�"__.....""Liriing materia I... Diamete'r__.33----____"".Depth"... v _,t�____ Cesspool: Distance from nearest well---�_-_--.------Distance from foundation-------------________Lining material---__.------------.------___-------. ❑ Size: Diameter------------------ - --------- -Depth-------------- ---------------------------------------Liquid Capacity_--------------- -------gals. r Privy:❑ Distance from nearest well----"----------- --------- ------------- _ ------ Distance .from nearest building_---_ _ _ _------___----__----__-----..---- _ Distance to nearest lot line ' `------------------------------- ------------ ---------------------- Remodeling ---------- ---•-- Remodelingand/or repairing (describe): --------------------------- ---------------------------------------------------------"----------------------------------------------------r=-• �. .---- i --------------------------------------------------•---•----•-----------•--•--- -----------------------------•-"-------------------•--------------------------------------- ------------------------------------------------- f. ------------------------------------ ---------------------------------------- ---------------------------------------------------------------------- ----------------------------------------------------------------------- I hereby cer ' that I have prepared this application and that the work will be done in accordance with.San Joaquin County ordinances, St e I si and r les and regulations of the San Joaquin Local Health District. (Signed)------ - ----------- --------------- .- and/or Contractor) - ---- ---- ---- ---------- ---- --------=-••------------------- "- caneror t --- -Title----- - (Plot plan, showing size of lot; location of system in relation t ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' -- ------ -------------- ------------------------ DATE_ =a g� ----------------------- REVIEWEDBY --------------------------------------------------------------------- --------------------------------------------- DATE-- BUILDINGPERMIT ISSUED------- I------------------------------- ----------------------------------------------------------':DATE----------------------------- ----------------------------- Alterations and/or recommendati ns: ----- - --•------------- -y -G�-�- `------ r2�:evt � s'�-'�-----=---------- ----------------------------------------- ------------• ------ -------------------------------------------- ----------------- ---- --------•--- -------------------------------------- ----- --------- �4 FINAL INSPECTION BY: �c ------------------------- Date -- fL' �--- ------ ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT / 1601 E.fie:elton Ave. 300 West Oak Streetf �; 124 Sycamore St eet • i4 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracyr California rG 9 REVIFEG 8-54 3M 3-'r:3 F.R.CO.