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FOR OFFICE USE: /o S 3 + --------------- l " APPLICATION FOR SANITATION PERMIT Permit No. 5 . ----------------- -- --------------- ----------------- ---------------------------------------------------------- ` (Complete in Duplicate) I This Permit Expires 1 Year From Date Issued Date Issued --- -- --------- - ---------- ------ I x 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. S49. JOB ADDRESS AND LOCATION-W, Q� ___� .f+� 'L �- 6 ----- Y_ rQPhone " Owner's Name ------- , ------------ ------------------"-------------------------------- ----------------------------- --------------------- Co - - -- --- • -- ------------------- Contractor's Name---- - ' /_ r---------------------------------------------"--------------------------------------- Phone •----------------•--- Insfaliation,will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 r Number of living units: _/___ Number of bedrooms Ate--- .�6� -- Number of baths _/___ Lot size� , V___�_' _____________________ Water Supply: Public system ❑ Community system,❑D Private Depth to Wafer Table 4/pO ft. Character of soil to a depth of 3 fest: Sand ElGravel 0 . Sandy Loam ❑ Clay Loam I] Clay E] Adobe Hardpan F] i I i`, Previous Application Made: (If yes,date--------------------11 No I .if New Construction: Yes El ".No FHA/VA: Yes �'No E] TYPE OF INSTALLATION AND SPECIFICATIONS 1 ' .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: b7sfance from nearest well--� --------Distance from foundation--�Q --Mil eriai f'+------------------ __._.__- _-. �f 'b ' f. Size, I -"--- , _Liquid depth .--------------Capacity_ --- No�'of cp[nf„part�enfis "-®Z_�r-"�-" F � -- , i� er of likes"are t l . - ____ engin of eachound ti _ `___.Distance to nearest lomat line_ --------- Disposal .. Field: `Dutaboe frorrr.,nearest well�_�_ ._-Distance from line_____ _ _$ � • / _ Wldth of french ---------------------- T pl of fiber maferial`r. / fr __ .__ ___Depth of filter'material__ .._- Total length__-�a______________________________� Seepage Pit: Disfance to nearest well Oa-_-___Distance fr m found,ation___ i?__ _.Distance to nearest lot rsin. maferial_ __.. -A�__-Size: Diameter_ ._.__._.___De th _-_.�_...________________ Iwml�er of pats " ,k � p ^\�,1 #, 1 Cesspool: Dista3nce from nearest well __________--_�is'tance from foundation--------------------Lining material-------------------------------------- IJ Size ;.;Diameter----------------- -------------------Dep ` -------- :------------ _ ---------------Liquid Capacity----------- ----------------gals. \`► Distance from nearest building __._____________________ t Privy:, Diance from nearest well._-____--- °� ---- g -" ❑ Distartce to nearest lot line- -- -------------------------------------------------------------------------- Remodelingand or ream describe :___ _. ,� - - -- �� / = � - � � ' ------------ ------------ c- P. --------------------------------------------- --------" -•---••------------------ . .j.,------�-`w----- .....,,�•... .x S� v V --------- -------------- ---------- ---------- ---------------------------:------;---------------------------------------------------------- ----------I----------------------- ., l hereby certify that I have prepared this application and that the work will be one in accordan�e with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.. i -- � � -------- ------------ ---- ------- -----------;'------- ------------ � -_I�r Contractor) _ (Signed)- ------------- ---�1--��-� -- "- -- - - , 2 P By:----------------------------I---------- --------------- --------------- ------- -- ----- -- -- --- -------------{Title) F ----- --- --- ---- ---- - (Plot plan, showing size of lot, location of system i r ation to wells, buildings, etc., can be placed on reverse side). i , I —FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ------- ----------------------------------- DATE- - ----- ---------- REVIEWEDBY------ ----------------------------I----- ----- --------------•---- ---------- ---------------------------------------- - � DATE ------------- -------------------- ------------------------ DPERMIT --------- - DATE s r---------- ----------- Alterations and/orrecommndation , -----------•-----------------------------------------------------------------•------•------- ' ----------------- ----------------- ---------------------- ---------------------------- I ---------------------- ----------------------------------------------------------- ---- ---------- ------------ - ____________ FINAL INSPECTION BY:.--- i Date �',M,:�r ,.,�•---��_�-' SAN JOAQUIN LOCAL HEALTH DISTRICT , - 1601 E.Hazelton Ave. 300 West Oak Street `=1 24 Sycamore Street 205 West 9th Street Stockton,California { LodirCalifornia Manteca,California Tracy,California F.P.CO. i