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APPLICATION FOR SANITATION PERMIT Permit No. _-JI-_'�___ �________ [Complete in Duplicate) Date Issued -----------------------l -- --- l Health District for a permit to construct and install the work herein de Application is hereby scribed. made to the San Joaquin Local This application is made in compliance with County'Ordina a o. 549.,. r JOB ADDRESS AND L CATION._070 '� ------------------ ' l ---- 0- - a �/ I Phone-------"r-------------------- Owner's Name.---------- ) -------- i - -------�- -7 Aq --- -----------------••--------------- Y r. Address----------------- c ; 1------------ -- ---------------------------------•----- ------------------•--- Phone------- Contractor s Name___-.- _---•- ------- ------------------------- - e ! a Installation will `serve• silence )Apartment House -Goy rcial ❑ Trailer Co ❑ Motes ❑----------------------------------- Other ❑ ^.,. f .__--_---------------- Number of livin ' units: _ ��- - Number of bedrooms ___.1-_ umber of baths _____--_ Lot size g 1 1 € [ Water Supply: Public system f❑' Community system � Private ❑ Depth to Water Table v .__§t. I I Adobe Hardpan Character of soil to a depth of 3 feet:y Sand;❑ Gravel ❑ 'Sandy Loam Cla:�,Loam ❑ Clay':❑ ❑ Previous Application Made: Yes ❑ No [ New Construction:`,Yes �o ❑ FHA/VA: Yes 0 No PP i TYPE OF INSTALLATION AND SPECIFICATIONS: :�� [No septic tank or'cesspool permitted if publicseweris vailable within 2200 Get-j' fi s i S t _iai�_ Septic T Distance from nearest well---�__-_Distance .from fo ndation__.__ Ma e Q _____ f� _ r r No. of compartments- -- ize_ S Liquid depfih_....___ _�. ._.___--Capacity ., f I � I ..__Distance to nearest lot I•��_ ('�j Disposal F e d: Distance from nearest w I �f Distanceom foundation____-_- ------- Number of lines___•_'----- •-------_ -Lenpgt'h-of each --- _�-: - f Totalhle gth nc a j- --'----- Type of filter material---_- ._.De th_of_filter material__ -_ -__- -___ I Seepage Pit: Distance to nearest well-__�---------------_-Dis farce from foundation-_-____:___.___.._:Distance to nearest lot line.__.___.__.-____ ❑ of pifisr.-- ---Lining material-•------------------Sizeiameter---------- ------!-- .Depth---------------------------------- Number1 z { Cesspool: Distance from:nearest well ~~ """"Disi 'from founda#ion_:_-___�_____-_.Lining material__________________.___-.___.____._ Size: Diameter------I-----=--- ------Dep fi-� -----------• ------------E.`L"ici did apacity gals. Privy: Distance fromNearestlwO------ ----------- ----- ------�t------------Distance from 'nearest;building------------------------------------ ❑ Distance to nearest lot line-- l ) 1- --- -�}-- ---------- ----------------- --------------------- -^ or re In decribe :_ `- --- ----=----- _ - Remodeling and/ 9 { �� --- ---- ---- ----- _ _ . ' f • -- ----------------- ----------------------- ----------------------------------- ------------------------- - t i '------- --•---- _. r reb certify that I have Irepared.this a ation and that the work will 6e done in accordance 4 -------- --------------------------- 4--------- - )-------- Ihe ordance with San Joaquin curry ordinances, State law nd les and ns o rhe San Joaquin Local Health District. (Signed) s) I . -------------•------------ ----- [Owner an or Contractor ----------- By: -------- s By:---------------------------------- ----- ', -------------------------------------------------)rifle)---------------`------- -------------- 7777777- (Plot ------- 7 - (Plot plan, showing size of lot, locafion lof.sysiern in relafion to wells, buildings, etc., can be placed on reverse side). I ) FOR DEPARTMENT USE ONLY I E DATE ----- - fAPPL1CATlON ACCEPTED BY E r ---------------------- REVIEWED ----------------DATE.--------FI-- -- 1 ' -----= BY---------------•---------- - Bl11LDING PERMIT ISSUED_ --------------I-------------------------------•--------------------- ---------- ------ F ,.E , ATI-!-----•- ------------------------- Alterations and/or recommend ations:-- ) ------ ------- = --------------------------------- t: - � - 4c - � , s - -------------------------- ---------------------------------------------------------- ---- -------------- ------------------------------------------------------------- . ----------------------------------------------------- ---------------- ---------------------------------_ ._ -- _ --- -- ----------------------------------------------- L Dades-- -- -- ----------------- - - 1=1NAL INSPECTION BY__________________ _ •- - - --------------------------- - - ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California ES-4-21x1 , Revised 1-57 F-P.CO. �«" "