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APPLICATION FOR SANITATION PERMIT Permit No. <br /> ................ ...... ...... <br /> ....... (Complete in Duplicate) Data-Issued ..Z�V <br /> .......... ........... .......... z,4* <br /> ------I............. ......... This Permit Expires 1 Year From Date Issued <br /> ...................... <br /> pplic <br /> permit to construct and install the work herein described. <br /> a n is hereby rnad�j�fo the Son Joaquin Local Health District for a p ru <br /> p c With CountyOrdinance o. 549. 4e"-) <br /> fion is made in �omplianc <br /> MAI <br /> p <br /> his <br /> ESS CATION_Oa ADDR ----- .... <br /> ? - I I .,:.- Phone...................f......r._.._...-- <br /> " 'u-" '' <br /> ...................... ..................... <br /> Owner's Name .. ..... .. ..... ......... <br /> 0 , ........................ -------- ..........*....... <br /> Address......... ..... .. .......... ---- ------ .. ....... . ........................ <br /> Contractor's Name..,. ._. ..... ...... ....... ...... .. <br /> ... ...A.................. ......... Phone........................... <br /> Installation will serve: Residence j Apartment House❑ ComderciAl, Trailer Court C] Motel [I Other [i <br /> Number of living units: .1... Number of bedrooms Number baths;2—.,- Lof size ......... ------ <br /> Water Supply: Public syst m [I Community system C1 Private Depth o Water Table ff. <br /> Character of sail to a depth of 3 feet: Sand 0 Gravel [I . Sandy Loam[A Clay Loam E] C-lay❑ Adobe❑ I iard4an n <br /> Previous Application Made.4 (if yes,date...........:--------) No Fj New Construction: Yes [] No [] FHA/VA: Yes ❑ No[I <br /> TYPE OF-INSTALLATION"AND.SPECIFICATIONS: <br /> (No septic tank or cesspool I permitted if public sewer is available within 200 feet.) <br /> Septic ank: Diitan6e from nearest we'll 4W,_Distance fm foundation...._ ......... <br /> No. of:compar 1 15.1 'or- ./ <br /> tments....7_� ............ depth. Capb4ty_t4�4.1 C <br /> r <br /> from <br /> -Distance from nearest well.---- V foundation.....1_0 <br /> Dispos field: - o..4!--.Disfance ...Distance to nearest.lot line. <br /> Number of lines....__. _'Length of each line_.,._..6-9�... ,,_Width of tranch"'.7—/-------------........ <br /> Type of filfer material..... . .-_Depth of filter material --Y. .-.-Total length--_.-- ................... <br /> Seepage Pit: Distance to nearest well__...... ........Distance from foundation--_-____---:-----:Distance to nearest lot line................ <br /> . . .Size: Diameter..-.. Depth_._._._.... <br /> ❑ Number of pits.......................Lining material_,......... .. ........ . <br /> .......... <br /> .................Distance-_......Distance <br /> Cesspool. D;stari6.e from nearest we or <br /> 'qe�ffi I -------�_..Liquid Capacity------_-_ _2:�rgajs. <br /> Size; Diameter.............•-••-_----................. ............ .............. f <br /> El <br /> Distance from.neares� b6ilding................. <br /> Privy- Distance from nearest well_---- Y_....__------......................Dist --------- wl❑ --. <br /> ...................... ....... <br /> Distance to nearest lot tine....__- .....................I........... ------- <br /> Ile <br /> Remodeling aqoy��ir��q ... ........... ........ ------- .............. <br /> .......................I...................:................... ..........Z. ................................... ................ <br /> ...........:w......................................... <br /> .................. ..........I....................... ...................... <br /> ...............................I............ <br /> !. .......i -------- <br /> .............. ...................... -•---•-••--•. •-..._ .......................... LiVC*unty <br /> I herebycertify fhave prepared this application and that the r will be dope in accordance with San Joaq <br /> ordinances. State and rules and regulations of the San Joaquin LocalHealth Visfrilr-4- <br /> Contractor) <br /> 'for) <br /> _anj/or, n47rac <br /> (Signed)......... .. ...................... .. . .....:............­............. .................... ......... <br /> By:......... • <br /> .. .... ..... .. .... ---------- ...................................... <br /> W' s laced on reverse sidi). <br /> (Plot ']an. showing Sme of lot, locafioin of An,re 1*" 4; wells, 6uiIdings,;,e+c.,,can.,be,p <br /> p <br /> `FOR DEPARTMENT USE ONLY,,,' <br /> 74K i <br /> .......... <br /> .......... ......... <br /> APPLICATION ACCEPTED BY ................... <br /> ----_---------JDATE..:............._......................................... <br /> REVIEWEDBY..._.... ­........ ....... ..................... ....................... % <br /> "D TE ................. <br /> BUILDING PERMIT ISSUED---------------- --------­--------­-....................I...... ...........T.— _-----_--_----_-_--- <br /> ..L4�—4�, <br /> - -­---------- .............. ------- <br /> Al+erafions and/or recornmendations:.........._.................................................. ................ . ....... <br /> .__14-+ _.............. <br /> ............... ..... <br /> .......... ................................ ........................ ........... ... <br /> ............. ............ ....................................... <br /> ­....... ......................_­... ..................... <br /> ............ ....................�­ --------------.................................... -- - <br /> :!,.. ................................................. .............­.______,_­� ­.­............... <br /> ..........:.........-.1...............................................­ .............. <br /> ............. .................................... <br /> ...................................... .............................I.............. ....... <br /> B 74y ....................... <br /> Date.... .............. <br /> • FINAL INSPECTION y ---- ...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.HoWlen Ave. 300 West Oak Street 124 Sytam*ri Street 2 Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />