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tF R OFFICE USE: . Q, �6 . -�-L� --------------- - -- - _� Permit Nc� -- •-- --- •--•..--•- ------- j APPLICATION FOR SANITATION PERMIT ,.. (Complete in Duplicate) -�.- - � Date Issued This Permit Expires 1 Year From Date Issued t ; +Application is hereby made to the San Joaquin Local Health District for a permit to construct and install-the work herein described. his application is made in compliance with County.Ordinance No. 549. , '6'b ADDRESS AND CATI N--..-,T--------�- ---- - ---------------------- ---------------------------•----- ----- tQ � -------------- ---- owner's = Phone - " !� � ame-------_------___ -- - --- , �I l� "� .. - Ad'dress-------•----- -----••---------------'"r- ---... ----=-----•- - - - ------��-�---�-•--------------------------------------------------- Contractor's Name----------------- --- �' �- ------•---------------=-------------------- Phone.. Installation will serve: Residence {Apartment House ❑ Commercial E] Trailer Court ❑ Mote! ❑ Other ❑ Installation gip , I Number of living units:,----I-" Number-ofrbedrooms__`��Number,of.baths Lot_size "___"-. ___-" - -" Water Supply: Public system Community system ElPrivate ❑ Depth to Water Table _-"-____ ft. ' I. 1 Clilaracter of soil to a depth of 3 feet: SPpcation yes,d __-- ----------_1 E] Gravel ❑ Sa y Loam [I Gly Loam El Clay ❑ Adobe ardpan ❑ Previous Application Made: (If ate- . 1 No NC]ew Construction: Yes❑ No FHA E]/VA: Yes No ' within TYPE OF INSTALLATION AND SPECIFICATIONS: 1 ;� li (No septic tank or Less neares delf public sewer 7o01feet.) P P Pavailable S10 ei 4c-Tn,1 -. Distance fro MaterialNo. of compartments- --- Size •-Liquid depth--------- ----------------Capacity-----------------_- ------Di'spd: Disfiance from nearestwell...._".".---.--_.Distance from foundation------------------Distance #o nearest lot line---" ___---__. , I�lumbe of lines ------Length of each line-----------M------------------Width of trench-------------- of filter material'-_- Dep th of filter material---�-------- --- -- Total length-----------------=--•------------- ' ---.___.D'stan+e�.to nearest lot {fine-_____.-- -�-.- 6. Seepa �t: Distance to nearest w�jll____-.� ibis anee fr Ff 1.n&ion -.l.- J[ Linin material•_ l�''�lL3ze: Diam ter -------Depth----- = Number of pits------_-_- - g C, - . Cesspool: [Distance 'from nearest well _-----Dis#ance from foundation-_.-._-__.-:-_.-..Lining material_-.-__ N IS El Size: Diameter i -------0 11Liquid Capacity----------------------- as. ------------- De th .g� ..Distance from nearest building `-- Privy: —Distance from.nearest well---- ---------------*�- � 9 Distanceto nearest lot line------------------- --------------- --------- ---------------------------------------- ----------------------------------- ------ --- - F -- ---------------I------------_----__----_.-------------------------------------------------------- I -_-._-_---_-___---.-___---_-_--____--- _--_-------_ ' Remodeling and/or repairing (descriL�e}:."____"__"------------- --------- ----------- - _ t ------------------------------------I----------=------------------ ----------------------------- --------------------- �1------ -------- = __. -----.---------- ----- - ------ _ € -p -p-- pp - - - � -- --------- ------------- --------•um Local Health � of the San Joaquin I hereby certify that I have prepared this application and that the work wtll be done in accordance with San Joaquin County District. ordinances, State laws and rules and regula+eons q ' I� = - --, _`` (Owner,and/or,Contrac#orj (Signed)-.- -_ ------------;W 1 B ' ------------------------------- ------------------ ------------------------ ------{Title)-- (Plot plan, showing ze of lot location'of system in relation to wells; buildings, et�, can be.placed,on fever se side). E� FOR DEPARTMENT USE ONLY 1 t APPLICATION ACCEPTED BY------------ ---/------``. DATE----- I-- '' - ------------- ..� ; DATE-----------------------•------- ----- REVIEWED BY'---------------------------�-�.� .: �. - •------------ DATE- ------- -- -- BUILDING PERMITISSUEO -------•-------------------------------- Alterati ns and/or re omm d ion •__._-___-- - ---------------------------------------- --- � �fQ .. =-------- ------ �i -------------------------------------------- -- ------------ -- ------------------- ------- -- ---------- N- -- -- ..------ -•---------- - � -------------- - f - _. i--?-- - ---- ----- -- i Date.-- y;,° FINAL INSPECTION BY:_..... ... SAN JOAQUIN LOCAL HEALTH DISTRICT f- 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California MantecaFGalifornia Tracy,California II �•. " . E5 9 REVISF=d 8-59 31.1 3-'63 f.P.0 C. y