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FOR OFFICE USE: S APPLICATION FOR SANITATION PERMIT Permit No. --------------------------- ------------- . .la..... {Complee•an Duplicate) ` ..._. This Permit Ex ires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health-District for a permit to construct and install the work rein described. This application is made in compliance with County Ordinance No. 549. � (/� s JOB ADDRESS AND LOCATION._✓. ` ------� O fes._..._. ---,�7n----- '� 6�--. � .? I� , �, ' Owner's Name---•-----* / se's------- e Phone--------------------- -------- ' - � €_ dres ...... . G . .Ad = .& i 4 Contractor's Name--------- _ 1d r �/�A (/Pi----------------------I--. �- -• --- ----- ------- -------------------------------- - ------.-. Phone----------------------------------- Installation ----- -•--•---••-•-------------•-•Installation will serve: Residence VrApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ry❑ Number of living units: .____ Number of bedroomsiy __ Number of baths �.... Lot size .1 - 1�( _-_�---------------- Water Supply: Public system ❑ Community system ❑ Private (l-1epth to Water Table - /ft Character of soil to a depth of'3 feet- Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date__---_.-.__.-.----- I No Construction: Yes 1A/"lo ❑ FHA/VA: Yes R— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ Septic Tank: Distance from nearest well---�sr_/_Distance from foundation-AZI---------.Material /'� �- No. of compartments___,_f_._________ ______Size�KX46---..-!lX3_Liquid depth� - _..._..Capacity_,C Disposal Field: Distance from nearest well..:f. .-._._Distance from foundation_o2 ..._._Distance to nearest lot line-40 ------- Number of lines.--__•Y------_ -Length of each line TO__...Width of trench...---- ---------------------- Type of filter material " -Depth of filter material--/ �__-._.-Total length__X4V__------------------------- Seepage Pit: Distance to nearest well-_-.____}____.'. _. Distance from foundation----_--------------Distance to nearest lot line----------------- xc ❑ Number of'pits---i—------`---Lining raate�ialb_/ _t --------- Size: Diameter------------------ ----Depth-------.-------------------- --_- Cesspool: Distance from nearest well ----------------Distance from foundation_•-__-____ ... ..Lining material--.-...____.-----_-_.--.----_-_--.._.. Size: Diameter. ._ .. __-- -.-._-..De th___-_".... ... ........... .... " 'Li uid Ca acit -gals. ❑ ------ ------: P -: q - p Yom- - ---• - ------ Privy: Distance from nearest well...... ........... r ,.Distance from nearest building_ ._-_-----.._ ---- . ❑ ;�- r Distance to nearest lot line----------'----- -----------= n t Remodeling and/or repairing (describe •----- ------------------------------------------------------------------------------- ------------------------------------------------ } _ i r ,T --------------- -------------------------------------------------- ---••------------•-------------- --------------- --------------------------------------------------- ------ ----r----------- - -- - I hereby certify that 1 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. (Signed)------------------ '--/"rd r...�4� ------ --------------------------------( e#`Contractor) By---------------------------------------------- ----------------------------------- -=-- -------- - -'------- --------(Title)....� G � --- ----- -- _„6(Plot.plan, showing,size of lot, location of tem in relation-to wells, buildings, etc., can,be_placed-,on.reverse_side)._- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED DATE...... -------------- ----------------- REVIEWED BY--------------- ------/-------. DATE----- ---------------- ------------------ ----------------------------- ------ ----------- ------ ---------- --- - - ----------------- BUILDING PERMIT ISSUED-'.-. -- -. ------ DATE---------------------------- - --------------- Alterations and/or recommendations------------------ -------- ----------------------- ----------- - -----------------------------•---•---------•------ ---------------------•----•------------ r ---------------------- - ----- -------------- - ----------I---- ------------------------...---- ---------- --------------------------- ------ ----------- ......................... ------- -- . ------ ------------- ------ --------- -------------------------------------------- ------- - --------------- ----•-- -------------- ..................... ------------------------------- FINAL INSPECTIO Y: - Date------. f,9--- --------------------------------------------- A JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street. 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California f � Tracy,California E.H.9 2M 1-67 Vanguard Press