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FOR OFFICE USE: --------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ',17. Y ---------------- -- ---------- ---- --- ----------------- (Complete in Duplicate) -------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for '/bi " I?P Y q permit to construct and install thet(�15 `erein Ag ed. This application is made in compliance with County Ordinance-No. 549; '.4 JO8 ADDRESS A D LOCATIO �+ �, O _,e_--- ---- - ---h P - Owner's Name__ _ -- --- .--`-- - -------------- - ----- Phone__. Address------- -off'-au, ------ ''------- r � .. G r• - Contractor's Name---- s + ZApartment r ------- . .. A c -------------------------r----- Phone------------------------------A.- Installation will serve: Residence House Commercial❑ ❑ Trailer Court ❑ Motel ❑ Other ❑79 Number of living units: --/--- Number of bedrooms _> ___ Number o;baths _ Lot size ------Lr r_________________________________ Water Supply: Public system ❑ + Community system ❑• Private e. epth to Water Table __„____ ft. Character of soil to a depth of 3 feet: Sand [] - Gravel ❑ Sandy Loam ❑ Clay Loam eclay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------._._..__I No ❑ New'Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ? r (No-septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well---710- Disttom foundation_'_A` ...........MateriaL___- ------- ---------- No. of compartments_ _._-----------Size_ --.: l --XLiquid de th_____-.Jr ------------_ �C Dispos Field: Distance from nearest well._„5L}_._._.._Distance from foundation___.,d_0----------Dlstance to nearest lot lrrhe_ ----------- I � Number of lines_________ ______ Length of each fine, 4f''.y �- •r`&1Nidth of trench.__r, � ___ ____________ Type of filter material <i►_,--------Depth of filter material_____ _ ___ ________Total length------ See pa Pit: Distance to nearest well----„d_C4(3___-----Distance from foundation___,___'____.Distance to nearest lot line___..______._ ` Number of Pits__. Unir9 materialSize: Diameter-------- r Depth- _ _ ___ _ r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-_.__________.._.__________-____._ 9 Size: Diameter--------------------------------------De th----------------------------------------------------Liquid Capacity __gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------._-____. 3 ❑ Distance to nearest lot line.----------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ ---------------------------------------------------•-•-- ---------------•---------------------------------------------•----------------------------------------------------------------•-------------•-------------------------------------------------- ---------------------------- ------------------•------------------------------------------------....-----------------------•---------------------------------------- --------------------•---------•----------------------------------------- ------ ----------------------------------------•---•-----------------------------------------•-------------------------------------------------------------------------------------- I hereby certify that.l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawsd rules and re ulations, f the San Joaquin Local Health District. fff i a__.. _.__ _ and or (Signed)------------------ ------------------ --- --� - -- --------------------------•-------------------------- -------------------- Contractor By--------------- ! 1� --- ------ {Title)= = ----------------------.----- (Plot plan, showing size of lot; location o system in re{aion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------------------------------------------------------ DATE-------- 47 7(- REVIEWEDBY------------------------------------------- --------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------- -- • -------. DATE------------------------------ Alterationsand/or recommendations----------- --- -- ---- --------------------------------------------------------------------------•-----------------------•----------------•------------------- ------------------------------------------------------------•--------- ---------------------------------------- -----•---------= --------------------------------------------------•-------------------------------- ---------- ----------------------- ------------------•-------------------------------------------------- --------------------------------------------------------------------------------------------------------•----- ------------------------- -- --- .------------- ----- - -------------------------------------------------------------------•--------------------------------- ------------------------------------------------------------------------- - -----------------------------------------------------------•----------•--------- ------------------------------------ ---------------------•--- FINAL INSPECTION BY:...I ___P ' . / -------- ------------ Date---- y-------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelta"Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVtSEP a-59 3M 3-'63 F.P.EO.