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FOR OFFICE USE: _J---------- --- --------- ------ ---- - -- 1-.--?------ ------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. .-AY-7 6) �+ -------- ---- ----------------------------- -- (Complete in Duplicate) Date Issued - ---------------- ------ -------------------—----- - This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct ancu all-ther here described. This application is made in complianc6 with County Ordinance No; 549 JOB ADDRESS AND LOCAT12N----.21 -49- ------------------ Owner's Name-----------------------------411 ----------------- Phone----------------------------------- _7 -------------------------------------------------------------- Address--------------------------- ev) ----------- Af------------------------------------------------------------------------------------------------------------ Contractor's Name---------------A/-/Z>---- -- ----------- ----------------------------------------------------------------------- Phone----------__-----------I--------- Installation hone-----------_-----------I--------- Installation will serve. Residence M--<partmenf House [] Commercial E] Trailer Court El Motel E] Other [] Number of living units: Number of bedrooms Number of baths _/--- Lot size ___ .- -- - -------------------------------- /1 07 Water Supply: Public system Ell Immunity system [I Private El Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Son Loam Clay Loam E] Adobe [?t-�ardpan C1 cl Previous Application Made: (if yes, uM---------------- No [jj�Ne, [j Clay Construction: Yes [21-No E] FHA/VA: Yes Ej No g,--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool per i miffed if public sewer is available within 200 feet.) Septic Distance from nearest well.......'-------Distance from foundafion-/0---------Mate i a I wlc - --------- ------- Size------5__,6_,)0rK �d depth--- X.)----------Capacity------ ------- •___Liquid No. of compartments_.____. -------- Disposa from foundation /1'P./___Disfance to nearest lot line.4------------ ,L-Field: Distance from nearest w 11-------—_ Distance f �p- ----- Number of lines--- Length of eiach'line"�----#� - 1_!____._.Width of t,,n,h. EY' _I jW - ------ Type of filler material-- /1 !41ffepfh of filter material..-..- -------Total length____ / ---------------------------- See Distance to nearest well_ ___'—._._.___Distance. rn foundation__ --- Distance to nearest lot line Number of pifs--------f-----------Lining materiaSize: D7bmeter___-R Z-----Dept Cesspool: Distance from nearest well------------------Distance from foundation__ ________________Lining material_------_____----.__.____._._.._______ El Size: Diameter--------------------------------------Depth--------- ------------------ --------L__�-----Liquid Ca p.�ci�ty----------------------------gals Privy: Distance from nearest well---------------------------------------------------Distance4rom nearest building_._.__.______________________-.----_-_-- Distance to nearesf�161-line. ----—--------..e-- ------—-----------------------------------'-----------•----— - - ------------------------------- 'All ---------------------------- Remodeling and/or repairing (descriiUo--- ----- ------ ------------------------------I- --------------------------------------------------------------------------------------------------- ---------------------I-------------- - q ----------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- --------- I . ------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------- ----------------- I hereby certify tha'i`1 have prepare.d this application and that the work will be done in accordance with Sa'n,Joaquin County ordinances, State I and rules ireg'ulafions of the San Joaquin Local Health District'. State (Signed)------------ -- ---- -------- -----------------------------------------------------------------------(Ov�ner and/or Contractor) _*1ati, By:------------------- --------------------- ------- ---------------- (Plot plan, showing z of to location•of--sysfem in-relation on t,.O,-,Ils,,�'uildings,-e.fe.,-can.-be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----------- ----------------------------------------------------------------- -—------ ----------------- REVIEWED BY------------------------------ --- -- ------------------------------------ -----------------------------------------------`DATE-: -- ----- ---------- ------------------------------------ BUILDINGPERMIT ISSUED----------------- --- ------------------------------------------------------------------------------- DATE--- --------------------------------------------------------- Alterations and/or recommendafions- i..------- --------- --- ----------------------- --------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ ........_--------- C L ----------------------------------------------- ------ - ------- ------------------------ -------------------------------------------------------------------------------------------------------------------- --------------------------- ---------- --------------------------------------------Ir------ ------------------------------- -- ------- ----------------------- ------------------ - ------ ------ - ----------- ---------- ------- ------ ---------- --------------- --- -- -------------------------------------------------------------__------------------------------------------------------------------ FINAL INSPECTION -------------------------------- Date.. ------- -------------------- --------------- SAN JOAQU�IN LOCAL HEALTH DISTRICT 1601 E.filaxellion Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California L..i,California, Manteca,California Traty,California F.P.0 U.