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FOR OFFICE USE: - ti +4 -------------- -------I—,-------- ' " APPLICATION FOR SANITATION PERMIT Permit No. ..c . ' -'--'- --------_----- - -------- (Complefe-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 t and install the work herein escrbed. This application is made in complian -with Co ty Ordinance No._549. i JOB ADDRESS AND LOC TI r Owner's Name--------------------- 0.H-�-1--------- r _.:.. -fV' ,, } Phone. Address f-- --- ---�"-------13 'd` " i �-ice-'--------- �, . Contractor's Name------C-t± N- ...... Phone------ ---------------_--------•- -------- --------- ---- ------- ---- ---- Installation will serve: Residence. �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ , Other ❑ Number of living units: _�.-.-_ Number of bedrooms 3-.- Number of baths._. .. Lot size _.. _ '�-� �- i Water Supply: Public system ❑ Community system ❑ Private`�epth to Water Tableg - ft Character of soil to a depth bf.3 feet- Sand � Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan k Previous Application Made: (If yes,date................... ] No New Construction: Yes ❑ No FHA/VA: Yes ❑ No % - TYPE OF INSTALLATION AND SPECIFICATIONS: ermitted if public sewer..is available.within.200 feet j� (No septic tank or cesspool p Septic Tank: Distance from t east well ---Distance from foundation----- --------------Material ----------- ----------------------------_ AM y ❑ ments.--- -------- - Size------_----------- - ------Liquid depth.:--- - ---Capacity.-.. ------------ Disposal - -------Disposal Field: Distance from nearest well.................Distance from foundation-----------_--------Distance to nearest lot line-_-..-.----___--- \ I ❑ Number of lines----------------------------------Length of each.line-- ------------------`-------.Width of trench.-,-------------------------------- Type of filter material______-___--_----_Depth of filter material---.-----..... ..........Total length__-----.-..---..-._.------------------_.._ - Number of Iearest well.. "? -------Distance��from foundation__/_19_-.._-_�ista to nearest lot line_-`---_----_._ . See a e Distance to nearest �{ , r p -Lining material- ��.-- Size: Diamei;er__4----'--'-'----...Depth_---- 1--'-'`---------------- Cesspool: Distance from nearest well ----------------Distance from foundation_ ..---------------.Lining material-------------------_----------.-----. ❑ Size: Diamete0l- -------------------------Depth---- ----------- ...... Liquid Capacity----------------------------gals. Privy: Distance from nearest well._. _.�__._:.. _-_- Distance from nearest building------------------------____.__...------ ❑ Distance'to nearest lot'Iine_.__..._'.____._.._. modeling and/or repairing(desceibe);+j`-°` ' ' '---'-- "I WZ--------Wf}5-------- -.- --- 7F{-©off ' I' " 4TD Wo( 15------- { 11.nLC:� �?DN c}- - T--ZD------ .SJf R -I ------TO - Dy11�► R- r-:: SSS ?7 P�R.MA. t 'a - A LTi:oNMtfJ?�.A_�._ .'--`r i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and-rules and regulations of the San Joaquin Local Health District. ` (A y {Owner and/or Contractor)= -.-.: ----------- ------- - ------- " - rw Tit - ------- ' • --- ---- { (Pia+ plan, showing size of lot, location,of system In relation to wells, �I ings, retc., can be placed on reverse side]. FOR DEPARTMENT�USE•ONLY c.� __!�F_V-------------- DATE-- APPLICATION --- ------ ' REVIEWED BY-------------------------------------- i APPLICATION ACCEPT D 13Y,__- ._ t•.,, - -' --------------------------- ----'- ----'-------------------------------------- DATE---- ------------------------------------------------- BUILDING '---"-'- --'-----•---------------------------BUILDING PERMIT ISSUED-------- ---- --------------------------- ---------------------------------------------------------- DATE--------- ---------------------------- ----------•----- Alterations and/or recommendation Ft - ------------------------------•-- ------ ----------------=--- ------ - --- - -----------' e 1. ------------------ - ........................................ 1/7 .......................................... ... __ _._--_-_.-_...--______•_.._.__-..--...--._.____..._._._.___...._.------..---....._-----..---------..-._..----- yyj FINAL INSPECT'ION..@Y' - -------. - Date------------- ------- --- �� -47. . _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. i 300 West Oak Street 124 Sycahore Street 205 West 91h Street Stockton,California ' Lodi. California Manteca,California Tracy,California E.11.9 2M 1-67 Vanguard Press �} ' '