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FOR OFFICE USE: I i ____________________ _ -f__ ___ ___-------- Permit No. --�-�3 --------------------- //- ��,�`^7_:__._ APPLICATION FOR SANITATION PERMIT ----- --------------- - -------------��'`F------- I ; [Complete in �uplicataJ - ------------------------------------------------- ------------------ This Permit Expires 1 Year From Date Issued Date Issued Application'ishereby 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 with County Ordinance No. 549. � Ir JOB ADDRESS AND LOCATI N_ ; i © Z �(A_ ]_f?.c'f l�. �=�--'-----------------------• s _: Owner's Namee7�_4.-R. ----•--•------• ----------------------------------------------------------------- Phone Ds . ------ Address. _a.h _g ... --- --- •--------• -----------•- 4 W N_C.R ---• ----- --- •---------- Phone. d 11 _-�_�oQ. nn j� ` Y? Contractor's Name--- = !-7----L__d_ _1. .-h - ------------- 7 Installation will serve: Residence &3`� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living,units: ___I__ Number of bedrooms .-Y }--- l- - Number of baths __. Lot size __ �S___________ ____ .-------------- 1 Water Supply: Public.system ❑ Community system ❑ Private 0 Depth to Water Table _leo,ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay dobe ET Hardpan ❑ Previous Application Made: (If yes,date_________________ __) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well_________________Distance from foundation-------------------Material ----__-_...______._______.._____._-------- ❑ No. of compartments ------------------Size-----•-•--------------- ---Liquid depth------------------- ------Capacity--------------t--- --- - Disposal Fi Id: Distance from nearest well-_-�p�_._Distance from foundation------1.Q_1-------Distance to-nearest lot line____ p ' =Length ch line_________ french „ Number of lines-----____-- �-S-______----.Width of ______________�-�_.------_-- Type of filter material_;. o :t�_'- Dept of filte material_____=�_I __'�_--Total- length_____________________�_S_�-:-.---- Seepage Pit Distance to nearest well____( .________-Dist e�rofo dation_____ _!:._.___-.Distance to,nearest lot line_____,___.---._. J GLGQ� Number of pits------- _____.------Lining mate i I lC___. ize: Diameter---_._ ... .___.D”epth...----------2-S--.---------- Cesspool: Distance from nearest well_____________._-Dish ce from founda -on____.______-_-----.Lining material__r__________________________-_____. ❑ Size: Diameter-----------------------• -----------Depth\ ------ -----------------------Liquid Capacity-- ----------------------gals. iPrivy: Distance from nearest well____._______________ ___________ __________ tance'from nearest building_________________________--.__..____... I ❑ Distance to nearest lot line____________---------------------- Remodeling __ __ v ---------------- ----------------'-------------------•-------------------------------- --- -------- Remodeling and/or repairing {describe):------- ---------V --------- ---------- --------------------------------- �r ------------ = r ------------•-------------------------.---------------- ---------- ---- ---------------------------•---------------•------------..._-.7------------------•------- -----------•----------------- ------ , 3. . I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County , f ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -----------------------------------Owner and/or Contractor) (Signed)-------D(`�� -----�aio, -------------------- ------ ----- ------ By:.-..------ ``�� {�.C?'`r�__ •- y `-----------------------)Title)-------- '.................... (Piot plan, showing size of lot, atirn ofs stem in relation to wells, buildings,-etc., can be placed on reverse side). ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- " --------------------- f - DATE f� -------•-------------- --- REVIEWEDBY-------------------------------- t ------ ------- DATE---------------------------- BUILDING PERMIT ISSUED--------- # r -----------------------------1 - ' . ------ DATE------ ----O----t-�------------------------- -------------- ,- '. C - - r Alterations and/or reco mends+ions:----- - --- --- n -----------•--------- �/? -� ---� ---_-. --�-`-'-3----- I ,. t i t ----------------------------- ------------ --------- ---------------------------------- ------------------ -----T -�-- ---------------------------------------------------------------- ------------ ----------------------------- ---------------------------------. FINAL INSPECTION BY:__.__ tr � - Date.... -------=------------------ t a F: N 1 -1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8.59 31A 3-'63 F.P.CD.