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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _- - =- � -------------------------------------------..----- -- (Complete•in Duplicate) Date 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 herein described. This application is made in compliance with County Ordinance No. 549. ' JOB ADDRESS A LOCATIONS - �� .C4 •- , Owner's Name----- ----------------------------------------------- Phone,----------------------------------- Address------------ ------------------.--•--•---------Address------------ -- ---�t�----- - - ----- ----- - -- ---I----- ------------------------------------•------- Contractor's Name----------- --- ---- - -------------------------------- Phone------ ----•----•----_---•------- Installation will serve:. Residence [Apartment House ❑ Commercial 0 Trailer 'Court ❑ Motel E] Other ❑ Number of living units: _-�--- Number of bedrooms„-- Number of baths-/-.- Lot size ----. ------------------------------ # Water^Supply:-Public-system'❑""Community'sysfem"❑"Private Depth"to Water Table=-'ft• Character of soil to a depth of 3 feet- Sand ❑ Graver ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ - t Previous Application Made: (If yes,date--- y#.;.:-.r._ I No ❑? New#Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ �NO ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic"tank'or cesspool pe�mitted-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------ - I Disp Field: Distance from nearest well.,/490 Distance from foundation--h .-_---Distance to nearest lot line.�.�------- Number of lines--•-----I------------------------Length of each line-------- ------------.Width of trench-crxr�--.-------_____--__----- Type of filter mate rial.---....�A_A___-Depth of filter material-.---/f--`.---------Total length___.-E0a----------------------------- Seepage Pit: Distance 'to nearest well----.------- `Di-stance'frorn'foundation--------___------Distance to nearest lot line_--_-.--.------ x Number of pits--- ---------------Lining material---------------------- Size: Diameter-----------------------Depth--------------------------------- l Cesspool: Distance from nearest well ----------------Distance from faundation._�-------------- ..Lining material-----------_-------------------------------------- F ❑ Size: Diameter -------- --- ---- - ---- --..Depth------ ------ --------- -------Liquid Capacity-------------- -------- ----gals. Privy: Distance from nearest well--- _.,.................... -----------------I---Dista'nce from nearest building----------------------------------------- 171 Distance to nearest lot line ... - - --------------- ----------------------------------------- --------------------------- Remodeling and/or repairing (describe) "r`"""_--::_ --------_-----=--------------- -•--------------------=------- --------------•-- ---- •------------- cae - = �----� - ---r • •------------ - -----------------------••------------------------------- i - ------------------------------------------------:------------•------------------------------•----------•---------------------•- ----------------------------------------------- ---------------------------- ----------------------------- --------------------------- -------------------------------------------------------------- - - ----------------------- w---------------------------- ------- =-----:-----------•---------- ---- I hereby certify that I have prepared this application and that the work will-6edonv in`accord'a'nce'with SariJoaquin County ordinances, State laws/-a- rules and regulations of the San Joaquin Local Health District. (Signed)---- ---- - eta and/or Contractorl U-71 By:. -- -- ---- ------ ------- -- ----------- -------------------(Title ----------------- -- - -- --- ---------- of -------- ..- Plot' Ian, showin size of lot, location of s stem in rel ion to ells'buildin s�etc.,`cari 6e41aced own reverse side ( P g' Y 9 P )• FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ,r i':.0 ----------------------------------- -------------- DATE---/_7-. Y REVIEWEDBY--------------------------------------------- ---------------------------------------------------- ----- '---------------- DATE------------------- BUILDINGPERMIT ISSUED---------- ------ ----------------------------------------------- - -------------------------------- DATE----- ----------- --------------- Alterations and/or recommendations----------- ---------------------------------------• ---------------------------------------------------- -------•-•- ------------------------------------- ------------------------------ ---------------.----•---------------------------- ---------------•---------------------------------------- - - - ---- -- ------------------------------ ----- ------------------------- ---------------------•--------------------- ----------------------- ----------- --- ---- -- ----------------......--------- ------------------------------------------------------- ---------------------------- ---------------------------- ------------------------ FINAL INSPECTION BY:----- l�/� '°"'PSA'' Date-..4?1..-.- _". . ---------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca, California Tracy,California E.H.9 2M 1.67 Vonguard Press