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FOR OFFICE USE: -3-------------------- ----------- ---------------------------- --------. APPLICATION FOR SANITATION PERMIT Permit No. .. --------- ------------------------------------- ------ {Complete in Duplicate} p /_. _/ a#e 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 here described. This application is made in com liance with County mance No. 549. JOB ADDRESS AND ATIO /a / l Owner's Name------- =-- -�- �-� --�--.�•1i?1--------------------------------- -------------------------------------------- Phone.........--------------------------- Address---------- --- -- -------------------- Address ----- --------------------•------------------------------------------------------------------------------------------------------------------- Contractor's Name---------f-- � --•: --0-a• ------------------------------------------------------------- Phone---------------•-----------•------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' f Number of living units: ----f__ Number of bedrooms __ -_ Number of baths 1----- Lot size -----+ __ _ _�1 � ___________._____ Water Supply: Public system ommunify system ❑ Private ❑ Depth to Water Table14 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adore Hardpan ❑ Previous Application Made: (If yes,date---------------------) No g�r New Construction: Yes ❑ No PeFHA/VA: Yes ❑ No 93— TYPE OF INSTALLATION AND SPECIFICATIONS: (No-septic-tank-or=cesspool-permitted-if•-pu61ie-sewer-is-available-.within 200.feet.)�ap r tic 7 n : Distance from nearest well-----------------Distance from foundation--------------------.Material ________-_-______-__ __.________---- -----_--__. "I No. of compartments-----------------------_-Size--•-------------- � Liq iu d depth�`"Y ��.Capacity W - I. pispos)'I Fie cl: Distance from nearest well___ r -.__Distance from�Fo-unclation______2__ -- Distance,D f .y..... .___ ,fo nearest lot line___+ WW -_=.y:g=__ Length-of-each-line___ -��------Z_ Woidthof trench--A_-------------Number�of-lines_�r.-�---- ! j ____-_....-e L tal le 5 M D�sancef tlo�neaaest llel�r~- _D scan �f �Itrerfoanda'tilon__►__f _Distance go�nesoine__ --- .� ' Number of pits__ _-- -Jl- Lining material -.Size: biameter_ _, Depth_ '�__ ' ,, Ce3spoo : Distance.from nearest --------Distance from foundation_ ____------ _______l inng material--'`_-------------------''----------- Z Size: Diameter--------------------- ❑ -----------------Depth-----------=-----=---------------- ---------! - Liquid CapacitYl-`-------------------]r'---gals. � Priv Ifo y !1 Privy: 4.... Dista ce from nearest well________________________________________________Distant from nearest building-______I__.___--__._____.-.-_._-_-_-- -. ❑ Dista rte to nearest lot line ,: -` ----------- (`{ l Remodelingand/or re airin describe : � r W4P4=�W----�_ ---------- --- ------ - I f ----- .� , - - - - : I:; ,gp - - I hereby ertify that I have pRepa. this pica ion a the he wrl e do in accord ce with San Joaquin bounty ordinances. State laws', and' ales_and regulations of the San Joaquin Lacai Health District. (Signed)------- - --------------------------- -------- ------------------------- �8wnar' or Contractor} S ' to wells, buildings, etc., can By: --------------•--••------------ ---------------- f (Title)-................._ ---------- (Plot plan, showing size of lot, location of system in rele be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- _ted--.---------------------- ---------------------------------------- DATE------ , '3-------------------- REVIEWEDBY------------ --------------------------- --- -------------------------------------------------------------------------------- DATE---------------------------------------------- BUILDINGPERMIT ISSUED----------------------=-- ------------------------------------•---------------------------- ---------- DATE------------------------------- --------- -------------------- Alterations -- -----Alterations and/or recommendations:-------------- --- -- ------------ ----------------1-••-----------------------------------------------------------------•------ --------------------------- -••-------------------------------••- ----- --------------------------------------- - - ••------------------------------ ------------�" .-�1 -? ee . - _--------._ = .� '-------------------------------------- ------------ ---------------- FINAL INSPECTION BY:.. t. .�se,�°�`------ ---•- - ---- ----- Date -------------------- SJOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street L124'Sytamorl♦e"Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISEO 13.59 3M 3-'63 F,P.CO. !