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FOR OFFICE USE: ----- R. -- -- ---I-- APPLICATION FOR SANITATION PERMIT Permit No. ----------------- f �--- (Complete in Duplicate) - Date Issued.-- (Complete This Permit Expires 1 Year From Date Issued --- ---------------------------------:---- ------- ;F. - a I{F i Application is hereby made too the San'Joaquin Local Health District far a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549�I l rte' N 6, -----_----- JOB ADDRESS A LOCATIO ---------�J--©� -- _`:_. --------------------------- Address -----•---•------- r-1- Phone-1` Owner s Name------ - ---- •------•-•------------ --------------••--•- ------��--- Address---------------------1 = `r`r" � --------------------------;--------•------ Contractor's Name---------------------- ----- -`� � - - --•------- Phone.......- --- P Commercial a Trailer Court ❑ Motel ❑ Other El Installation will serve: Residelnce Apartment House ❑ ❑ Number of bedrooms -- - r. ; —------------------------ Number of living units: - l --- Numbeyr of baths -�__._ Lot size ____.].r._.___I�__.__.._ - %wx Water Supply: Public syste ❑ Community system ❑,,,,�rivate Depth to Water Table _00- ft. 44 # Adobe Hardpan ❑ Character of soil to a depth f 3 feet: Sand ❑ Gravel ❑ Sandyoam ❑ Clay Loam ❑ Clay ❑ = No Previous Application Mader {If yes,date--------------------1 No ] New,Construction: Yes ❑ No� FNA/VA: Yes ❑ TYPE OF INSTALLATION `AND SPECIFICATIONS: i #=. (No septic tank or cesspool permitted if public sewer is availa6ie within 260 feet.) —t Septic Tank: Distance from nearest well-----------------Distance from��foundation----._._._-----_---Material"_----.------_r '._`�----.--_-------------------- ❑ No. of.�compartmenfs------------ -------------Size- --- ......... .. Liquid depth Capacity ..- � i Disposal Field: Dlstan e from nearest well.-J-PA-_�_-._.Distance fro>��found:ation.---4 .......Distance to nearest lot line--_-� _--.__-. Number of lines-----:.--)------...... ----- -----------Length of each line_!-------A-M-1-----------Width of trench---------- Number --------------- 4 . ' Type of�Iter material---S.-'�.DC-�---Depth of filter. -----_�__e'.!r___Total length--------------�--Q-`--------+------- . Ip' Seepage Pit: Distance to nearest dell__.--_�- _�--__Distance from foundation--__.- ;70..---.Distance to nearest lot line2w-41�--_-_____ kA Number of pits---------------•------Lining material-_S'-JU C k-Size:�Diameter.-.-c-Se...-_--.---Depth-------_---- ---------- Lbl I 1 Cesspool: Distance°from nearest well---------------=Distance from foundation_--:-_---- --.__.Lining material._:--_ _---__-------__----._ t ----------Liquid Capacity.... -- als. _ ❑ , Size: Diameter-----------------------.-------------'Depth------- i;c' _- g 0.+ II � ---_ --Distance from nearest building------------------------------------- - 06 Privy: Distance.'from nearest well___--._----___,---_-__ _ i z s. r ❑ Disfan�e`to nearest lot line.-=--- i--•----- -------------------- - - - fi 9 / repairing (describe)--------�"`-Y' ."---� Remodelin and/or re alr Y :fMl -------------------------- ------------------ ••-----• ----------------------------------------------•=---------------------------- . r. v* II + --------- --- I---------------- -- - € li i herebycertifythat I have prepared this appllcatian and that,i. a work will be done in accordance with San Joaquin County (r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. .o Contractor) (Signed)_. ------------------------------------- (Signed) (Own rand/or -- --------- - -- -- --------------------------------------- Y showing size o " -------- ----- - (Title) = (Plot plan. g lot loco+ion of syste in`relation +o wellslf buildings, etc., can be placed on reverse side). IF � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -' - -------------------- ------ - -- t ---------- DATE - _ -------------------------------•------- - -- - -----------=------- .- --- I -� DATE - REVIEWED BY------------------------.-- ---- --------•- - -- fI ------=- ------ DATE-------------------------------=- --- -- --- BUILDING PERMIT ISSUED :------------ Alterations a d/or ecommendations:_--_:--.-..._.--- , (� ,�) !��lE ._6.`� '-< `- - ------- ------- �c--.7`r --------- -------•-'-- ------------I------------------- ---------- ----- ----------------- -•--------------------------------------------------- ------------------------------------ - ----------------------- it # 111 ' _ --- f ,@ Date t FINAL INSPECTION BY:......-----`- -ct*�'----:-- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street IIManteca,California Tracy,California Stockton,California Lodi,.California 'I E5 9 REVISED 8.59 3M.3-!63 F.P.CO. rf