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FOR OFFICE USE: ................ ....................................... APPLICATION FOR SANITATION PERMIT Permit No. ..f '. ................................................ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. /90 P rt Pa ' 1� �• jW6 , JO8 ADDRESS AND OCAT ON .25,19�.11 Owner's Nam _ -z __... ................:............... Phone Address . � __. ..._�_ r:=r -- ---•- -•--- ------------------•--•-----..-------•- -----.._... _..... •---................ !- Contractor's Name._ -- ... --------------------.......•---------- Phone.................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ZTrailer Court ❑ Motel ❑ Other ❑ Number of living-units: _-':_ Number of bedrooms ^`. Number of baths J--'Lot size --_________-____ Water Supply: Public system ❑ Community system ❑ Private Depth to.Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam�1ay Loam ❑ Clay❑ Adob@,[] Hardpan ❑ Previous Application Made: (If yes,date........ ...........) No ❑ New Construction: Yes ❑ No ❑ FHA/: A:Yes❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.................Distance from foundation.....-....._._......Material._._......._._..__.____------_........... [] No. of compartments_....:....-----------r.--Size.................-..............Liquid depth__-----_......---_.-------Capacity_-•--•---______�_--__ Dis osal field: Distance from nearest well_...64_-_....... Distance from foundation;_ _f,�___:---.__':Distance to nearest lot line......_ ._.... I_ p� Number of lines______..__.......... ........Length of each line'._!___ -j..w_.._Widtli`of trench.._ I Type of filter meterlal__ r.......Depth of filter material._._.___ 9........ length___.._._._. -�'.:................:..:.... sup» 4 :r i.. ♦ 5eepeetle-W: Dist'ance'to' eaFes# well•.--. �`b._._:Distance from foundaton___.�:�?____.___.Dtance to I �I ne__- f f,.... Q Number of'ht �._:�..._.-._.--Lining material_._._ +r. Size: ' .._ ..1�._Depth..-• --- ............... Cesspool: Distance from nearest well_________________Distance from foundatio --------- n ,Vit_:_..Lining,timaterial__._-__..___________.____.--r_,f'- C ❑ Size: Diameter•-•--•-•-----•-------•..............Depth---•----•-•----................._ -_--_•--•--�.Liquid�Capacity........ ._.Jgais. Q Privy: Distance from nearest well.........._..............._......._..............Distance from ;se're'st-building............................... sf ❑ Distance to nearest lot line............... ' Remodeling and/or repairing {describe) ...........A -- �,� �•�'� '� - '%' �- ........-................................ :. O s1 �- T p I hereby certify that I have prepared this applica{ion and the+the work will be done in accordance with San Joaquin Count+ ordinances, State laws, and rules and regulations of the San"Joaquin Local Health%District. 4em (Signed)--•---------- ----------•--- :... - and/or ctor) -------------------------•-•,-....._._....- .._.... n a(Plot plan, showing size of lot, location o lotion to welts, buildings, etc., can be placed on reverse side), 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.........6:/:.... •---•••-••--_----------_-........................................... DATE_..- �-??.=��-�'-- ............ REVIEWEDBY.---...-.......-------_-----• --------------....---•--•--- •••----------•--•-•---•-_.... DATE..................•-----------------•••-•-....--.......... BUILbINGPERMIT ISSUED.......------•----•---•----- .................__..--- DP�TE.... --- ------- ............................ Alterationsand/orrecommen tr ns---------------.._..__....__.__:...--- ---._..--- r•-•-•-• ..........................................._.....................•-•----•--._.... . •---•----------------•-•-- •-• -• -......-.._... ............____----------.....-....-------............................._.......................................... .................................... ................................................. ......................................... ..........._.............................. FINAL INSPECTION BY:-------. '••-•------------•-••----- Date------- `3� f= - .......----------------,--------.. i SAN JOAQUIN LOCAL HEALTH DISTRICT Y 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street; Stockton,California Lodi,California Manteca,California Tracy,California E9 9 R6VIGED 9.59 3M 3-'63 F.P.CC. -