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FOR OFFICE USE: ..............:................. Permit No. ...................... APPLICATION FOR SANITATION PERM , . ....... ....................---........_, - .. j. (Complete in Duplicate( Date Issued ---9�//fie fl ...__------------ ._,..-------------.--- This Permit Expires 1 Year From Date Issued pp/_ 2-10- 35 14111111111111'Appiiiation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a plication is made in compliance th County Ordinance No. 544. JOB ADDRESS AND L TION./`# !.-. ...-...._ ... . ..T ..•- Owners Name... .... zrs en-,R ! �..... Phon4 4 ....------.t..7--f .... ->7 - z'------ -_... - -------- Address - -.............. Contractor's Name......... � --....................... on ..... _ . ... Installation will serve: R�idence ID—Apartment use Commercial Q - QTA ❑ Trailer CourtMotel Q_ BOtha ( Numbat-of% .living units:......... Number.of.bedrooms ....._. Number of ba* ----- -•-•• - --"^--' % Water Public system [�-Coinmuh'ity�,ystam ❑ Private ild/ Depth to star Table ..Q.. rt. j a `so7 to e'de depth f 3 feet: 1 Send Gravel Sand Loam Cla Loam clayAdobe Hardpan❑ Chat�cter` p ❑ ❑ Y y ❑ ❑ ❑ `� - S Previous Application Made: 1rf yFs,dlate...........:........) No Q New Construction: Yes ❑ No ❑ FHA/ A: Yes [] No[] TYPE OF INSTALLATION AND SPECIFICATIONS: (No sap#ie tank'oc cesspool permitted-if;pubBc sewer is available within 200 feet.) �• ( -. Septic Tank: Distance from nearest we11.'.:"'.'•.^."'.".":'Dis}ante from foundation....................Material.....--...._----------------........"..-.,...� ' ❑ No. of compartments..........................Size..._............... -.Liquid depth------.-....._._........Capacity............ ----..._Q. Dispos Field: Distance from nearest well....5_0..�...Distance from foundation.....f IO.. Distance to nearest lot line..... (. Number of lines..�......y)� .... Length of each Iine.�.0-!. A./W.,.Width of.+ranch-.,..._r------...................... Type of filter meferial...�t..r.:e,....Depth of filter material.-_.., .r --..Total length....../..31d_�-------........ ••• O Seepage Pit: Distance to nearest well..................... Distance from foundation...................Distance to nearest lot line................ � QNumber of pits......:---.....--.--.,Lining material.......................Size: Diameter........................Depth.....................:...........IIIi • Cesspool: Distance from nearest well..............._Distance from foundation....................Lining material-----................................ F1els.{`l Siie: Diameter---,'- ------ ......................Depth------........- - - - ......... ......---- --.............-- ....Liquid Capacity. ----------- --g Privy: .Distance from nearest well.. ................ ...Distance from nearest.building._._-.__._---.----_.-.-....I....... �a Distance to nearest lot line................................... ----•---------•--- Remodeling and/or repairing (describe):...: -.- ..................:......_.....------•----...-----•-----..:..._..------........----------------`------•-------...------.-----`\w ----------------'--'---.........`'-............_...-------------------'-....--......-_.......---_----- ..-.................-.......- --------....------ . .................._......-.........-......•... -`-------'----.._............_. I hereby ce Ify t at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a laws, nd rules and regulations of the San Joaquin Local Health District. od ... ..: ....---... .......... ............. ....... . .......................`--- ----......,-------....... ..(Owner and/or Contractot)' (Sign �._._....._ is ,-::= l irA .. . ........... ..—BIT .•- ! v �. ..._.�_.. �y aY9 ��" s ^deer.�s��, By:................. . . _ rtl ......-..............................._:...... (Plot plan, showing i .of.lot, o tion of system In rection to Its, buildings, eta, can be placed on rsverse.side). rr i' FOR DEPARTMENT USE ONLY .� APPLICATION ACCEPTED BY... .... . .............. DATE__- _- t- ----------------=----- REVIEWEDBY....-----------------------------1........... -- ......-.....................................-...................... DATE..... - ---------------- :... - BUILDING PERMIT ISSUED_-------.........................' ------...................... DATE.....---------.....................------...; - - Alterations and/or recommendations---------------------_........•,, -.......-...............----------------------- --........_........_............................................................................._...............-- ............ .......---_.._..............'--...............----+-----....... ..........................-.. ...........---.............. .................-......-............-.....---......._----'--......-....-................................ - .. t FINAL INSPECTION BY: l1e ?r.rt Date--.../f.'� x... ........................................... _._ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avs. 300 West Oak Street 124 Sycamore Street 205 West 8th Street ' Stockton,California Lodi,Colif.mia Manteca,California scary,eolifomia 95 9 REVISED 9-39.3M 3-63