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FOR OFFICE USE; ------------------------- ----- -------------- ------------------- ------- ------ •--- APPLICATION FOR SANITATION PERMIT Permit No. d............... I " = "� -------------- (Complete in Duplicate) Date Issued "----- •'-- - q P l This Permit Expires 1 Year From Date Issued �e Application is hereby made to the San Joaquin Local Health District fora permit to construct and install th work herein described.' This application is made in compliance with County Ordinance No. 549. JOS ADDRESS AND LOCATION �'� LN[aT '°' e j C7 G t % r1�D -12.5 O- ------------------------ - Phone ' ''6- ._ "t �1 f Owner's Name --------_-- -t_,-------•--------0-A•----- - N - , L Address l Et.c�-C" Int- S� - Phone------------------------------- Contractor s Name------a-e-o T l_--- --- t Installation will serve: Residence"K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms _�3_- Number of baths _-Z Lot size -------1-------f,I-S R--�------------- ------ I Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table - ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ I Previous Application Made: (If yes,dote.__.------- ---__} No"V New Construction: Yes No E] FHA/VA: Yes E] No j _ t TYPE OF INSTALLATION AND SPECIFICATIONS: : (No septic tank or cesspool permi4ed if public sewer.is available within 200 feet.) eJ Septic Tank: Distance from nearest well-- _SQ__►----Distance from foundation----.1--4-r-.----.Material.--�-_�F- TA_ �`M p '/�. ,/ 1�— + Capacity .. �'s'. ' No. of compartments_ 2----------------Size_S� JI-� - Liquid depth 4 ---- , Disposal Field: Distance from nearest well__- �.-_Distance from foundation---.---1-Q?------Distance to nearest lot line----J<.---_._-- ( g - .. g ---------------- / Type of filter material-- K.--Depth offf lter�mllater�al--7�-I- _.-_._Total filen th of nch--------------rye•,5.-0-.------ � .. �. Seepage Pit: Distance to nearest well_...f_0..------Distance from foundation-_---7:5_-____-..Distance to nearest lot line-.._-'._----.. Number of pits------ ----. ----Lining material�_Rk'g --Size: Diameter--------- -----Depth------------- �' ---------- - Cesspool: Distance from nearest well--.-------- --Distance from foundation----------- -----Lining t ! material-- ---.------------------ -------•-g,-a-l-s. ----Liquid Capacity ------- ❑ Size: Diameter----- -Depth------------------ ---------- Privy: - ------ Privy: . \ Distance from nearest well--------------- -------------------- ----------Distance from nearest building-------._.----------------_----.---------. Distance to nearest-,lot line-------------- ----------------------------------------------------------------------------------------------------------------- ------- ---- ------------------------------------------------ - c��_ SL- -------------------------------------------------------- Remodeling and/or repairing (describel:--------_f144iT� � -------N-k=--II-0------------- ---------------------- ------------- - _ ------------------------------------------- - -;y ` ------- ----- --- ------------ -�i y prepared Pp the San Joaquin Lo ork will be done;in accordance'-- -- - -- i ---------------------------------------------------------------------------------------------------------------- with San Joaquin oun y ! hereb certify that I have this a lication and that:�he:cal Health District., ordinances, State laws, and rules and regulations of q i.- ,�. ...,.... (Owner and/or Contractor) (Signed) ------ ---------- - ---------------------------------- &J4 t - � - < I � - -----------------------------------(Title)------------------------------ ----..... ---.-- ------ Y t - .�r (Plot plan, showing size of lot, location of system in/elation toll lls. buildings, etc., can be placed on reverse side). FFR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y ...-.__ i _. =- `iDATE_-°`til- �/ r ar y•^ 5 i � - ---------------- i ------------------ DA- TE-- REVIEWED BY-------------------------------------- ------ ----- BUILDING PERMIT ISSUED-------------------§-------- " -.� -- ----------------- ------- ----- Alterations and/or recommendations-------------- -- -- - -- ---•-------------- a --- _ ----------------- - - , 1 --- - ------_-- ------------ - -- ---- -------------------------- ------- ---- -------- (. . y T a� _.w /� ---- 4. Date M - FINAL"INSPECTION BY:.._-------------- �! _- SAN JOAQUIN LfOCAL HEALTWE I TRIC ' 1601 E.flaxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California F.P.r D.