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yOR OFFICE USE:
<br /> Permit No. _..... � J _•l.-} -�
<br /> d
<br /> APPLICATION FOR SANITATION PERMIT ! _
<br /> .:..,...._......_-•- . ....... _ (Complete in Duplicate) Date issued _..
<br /> 'l
<br /> __.... This Permit Expires 1 Year From Date Issued
<br /> Application is hereby made to the San Joaquin Local Health District for a permit to construe and install the.work herein described.
<br /> 7his application is made in compliance with County Ordinance No. 549. ,y „_,
<br /> JOB ADDRESS AND LOCATION._. / '�C... - '" du � �---
<br /> ......_..._..... . ............ ..................
<br /> .. ......_...
<br /> � j a 1 __-.........a..�..-.. .............Owner ... �'
<br /> Address...... .......i.. � � r It _n!!. 4?r sC..% !t✓ �- ..F tY �.. "•.....�*�`�A .
<br /> _..._. -?r-................................................ Phone
<br /> /J
<br /> Contractor's Name.._.. .._t' �..
<br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [)
<br /> Number of living units. ........ Number of bedrooms........ Number of baths ....._._ Lot size »..........------.........-------------------.......-.....
<br /> Water Supply: Public system ❑ Community system ❑ Privatee;��Zoam
<br /> er Table ....... ft.
<br /> Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Q Adobe 0 Hardpan ❑
<br /> Previous Application Made: (if yes,date...... .............I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:
<br /> (Ido septic tank or cesspool permitted if public sewer is available within 200 feet.)
<br /> _- Septic Tank: Distance from nearest well............ Distance from foundation....................Material.......
<br /> ...................
<br /> ❑ No. of compartments........................ Size.............. _...,Liquid depth..........................Capacity.,....-----.;.......
<br /> ,.» �
<br /> Disposal F' 'd- Distance from nearest well..._{'_ ..Distance from foundation.I Distance to nearest lot sine-...f�9..r
<br /> Number of lines.............. ............ ..Length of each line.._-__. -.. Width of trench..._... .......... .�';�� �-
<br /> 9 �,�-,-+�
<br /> Type,of.filter.material. Depth of filter material......-._.._/.......fofal length..........,,---- `................�
<br /> Seepbge Pit: Distance to nearest well....._`....Distance from foundation....................Distance to nearest lot line,..»,» -.._O
<br /> ElNumber of pits. ... Lining material-._.._._..._.... Size: Diameter......._..'.............Depth._...»» ».. .,:.
<br /> Cesspool: Distance from nearest well.................Distance from foundation..............»....Lining material_.......................
<br /> .........
<br /> ❑ Size: lDiameter..................................... ». ... ..Liquid Capacity............_._...........galsP
<br /> Privy: Distance from nearest well._....,,.,......»...,,»,......................Distance from nearest building........»..»,,,.»,,..».._......
<br /> F1 Distance to nearest lot line.......................»..... ..,.». ........ »_.. -------------------------- ...,».........
<br /> _.�f
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<br /> Remodeling and/or ronalring )descr,oe):............. ._.................»_..-'.. .. _,...».._.........» .,... ..»._.....,.»...... .......�.,»»
<br /> _.__ »._.,...»»».............,,_............................ ........ 1t� .. ...... ... ------
<br /> ........... ....»_,.,,......._ ......:f..;.:....».».,_:,..........
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<br /> :................._.._......... ........--...................._................................... ..---........._............. ».. .»».. _............__...... ....»...,.
<br /> 1 horeby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County
<br /> ordinances, State law and rules and regulations of the San Joaquin Local Health Distr`
<br /> Signed �•�'�j �''. . . . ....���r+1w, Q..a....
<br /> ........ ... ._.
<br /> _.....; iw1 �'-e7��elr�Contractor]
<br /> By................. ...........:........_......_............................._...._..._ .........{Title)................._... ..._............_......_ :
<br /> (Plot plan, showing size of.lot, location of system in relation wells, buildings, c,, can be placed oin reverse side).
<br /> FOR DEPARTMENT USE ONLY r •, 't :
<br /> _ _
<br /> APPLICATION ACCEPTED BY. ... ......... .......... w,»..».._ ,t--,>{/. ..... bAfE.i:. .._,.•,..,x..__....
<br /> t • i �'
<br /> REVIEWEDBY___ ...................... . ........... _..,......., »».,.,..»...»................."'DA��•. '.... ....-._.._.»,»,, . .....». .. .,
<br /> BUILDING PERMIT ISSUED... ..............._-»-------- ».. » _. . . l3,ATE ''.. .e.h.. ...........,.,.»,..»..»»».
<br /> Alterations and/or .recommendations-. »...... d..
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<br /> ........ ......_............ 4`.�:�.....................»»-..,,
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<br /> ................_., 1. `.e�,. ......... ....»,» _;,................_..., »......_..........»... ......_t,.r... »»»...._....«
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<br /> ....._ .�:
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<br /> .................»».,.•...........,......_»..,..........»»».....................,..................-______..__1r
<br /> FINAL INSPECTION BY:...,...... t- ----
<br /> . ,...._.._.......__._.._.... Date.-....»...»................................................. .. ..�»»»
<br /> 5AN JOA-UIN LOCAL HEALTH DISTRICT
<br /> 1601 E.HssoNon Avg, 1r 300 Wort oak Street . �..a j 124 Sycamaro 5tmot 405 West 4tit 5lrrot
<br /> Stockton,Californiaj/(,! Lodi,California Manteca,California Tracy,California
<br /> CS G nrvi9CD U-SSS 3M '.]-'63 r.o.,tn. i,i
<br /> F.4- ''
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