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' FOR OFFICE USE: r �` _________________________._________________________-___--_- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----- ------ ----- ------ ----- ------------------------- �. (Complete in Duplicate) , Date'Issued. ----_------_------------_---- __ ___ ,. This Permit Expires 1 Year From Date Issued - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance Ith County Ordinance No. 549. • � r f JOB ADDRESS AND LOCATION---!es% = 't= -----�77z�,-�-��0 ----•------- -------------------------------------------- --------- Owner's Name = � '-W --- ----.---- - Phone._.-... •---:--- ---_ - - Address �---±--- -L--G-�z 2 J' Apartment : �Y _,✓------ {Contractor's Name -. ---•-----------••---- ----------• ---------------- ----=-------•------------•---•- -------•------ Phone----•---....------.• ----------- Installation will serve: ResideHouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ,p Number of living units: __�_-_ Number rooftibedr.00ms�'_X- Number of baths _ Lot size_' _ z�-f _- ------ Water Su I : Public:system Comunit system., Private Depth to Water Tablev; ft. . PPY = Y ❑ YLY �❑ � � Character of soil to a depth of 3 feet: Sand p Gravel ❑� Sandy Loam ❑ Clay Loam ❑ Clay [:] Adobe Hardpan ❑ Previous Application Made: (If yes,date___..-__-------------I-No � New Construction: Yes ❑ Nox FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS:` . No se tic tank.or cess ool- ermittedYifpublic-sewer is available within-200-feet. Se tic Tan IDistance from nearest well_______________Distance from foundation------------------- Material------- ---------------------------- i No. of compartments------------------- Size--------------------------------Liquid d✓h----•---------------- p ___.Capacity Dispos�IFel • Distance from nearest w II,.-�1 `1_-__._-_Distance from foundation___ ��_�.___!_-.-.Dis#ante to nearest lot line_ _ �!?.._ $------------------------- Length of each line- - _- -- f. Width of trench.--_ . ._ •---------------.-- Number of lines_____, Type of filter .materiaLr � Depth of,filter material__:.!- _:___-.Total len.gth_- .-__________________ i 1 eepage Pit: Distance to nearest well-----.-----------------Distance from foundation--------- to nearest lot line__-__--._--._-_.. p Number of pits----4-----------------Lining' material--------:---- '"---Size: Diameter---- ----Depth----------------_---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------:L___Lining material-------------------------------------- 0 Size: Diameter-----nj'-------------------------------Depth--- - --------------------------------Liquid Capacity ----------- gals. ' - Priv --'YDistance from'-nearesf well ""'-__'_ --77 ---Distance from nearest building Y ------------- - g----------------------------------------- 0 ------- -------------- - ❑ Distance to nearest lot line a -------------------------------------------------- ------------------------------------------------------------ Remodeling and/or repairing (describe):--------- i / � 'r� 1L -----�f,�--•-------- ---- � = --- ------------- --------•------------ -------------------------------------------------- ---•------------------....--------------- -------------=-------------------------------------•-------------------------------------- ----------------------------------- - ----------------------•---------------------------------------.-- ------------------------------------------------------------------------------------- --------------------------- ow I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County - ordinance5, �Sptfe_l s� and rules nd re a Ions f the San Joaquin Local Health District.(Signed) z- ---- /`' -Z ----------------------------------------------------(Owner-and/or. Contractor) --------- ------ By:-----------------------------------=--------------------------------------=-----------------------=--------=------------------------(Title}------------------------------------- -------------- - - .... (Plot plan, showing:size of lot, location of system-in-relation-to wells; buildings,' etc;can be placed on-reverse side). Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------------------------- _-- -------- DATE_ -- f -- - --- REVIEWEDBY--------------------------------------------------------------------------------- ----- DATE /, ? ..r. _ -BUILDING PERMIT ISSUED---------- ------------------------------------------ ---------- --------------- --------------- DATE-- •----- Alterations and/or recommendations----------------------- ------ ------- -------------------------------------- ---•-------------------------•---•--------------------------------------- ----------------- -------------- -------------- ----------------------- = •-•------------- •-- - -- ------------------------------------------------------------ FINAL INSPECTION BY:- Date -` %. = SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5.59 3M 3-'63 F.P.0 O. _ '� r