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FOR OFFICE USE:
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<br /> ` ............. APPLICATION FOR SANITATION PERMIT Permit No.
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<br /> t r (Complete•in Duplicate)
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<br /> ......... This'Permit Expires 1 Year From Date Issued _ Date Issued .._.,..,...... {�..
<br /> Application is hereby maria to the San Joaquin Local Health Dis'.rict fora permit to construct and sfa5—ll C a,-�herein described.
<br /> This application is made in compliance with County Ordinance No, 549.
<br /> JOB ADDRESS AND L ,p TIO iN..�,. •j_.Ls1--/-:2X_...., 1 ... lee
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<br /> Owner's Name_
<br /> ....... ..... 1-�.•��-_1Y_ /. r �_, f1^'��-'
<br /> Address..............
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<br /> .. ....._._ ' .. hone
<br /> max . :,: ._ rpo—A,i..._� _._ _..-.
<br /> Confractor's Name....
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<br /> .......-------------------------- -----_. Phone._ _ O
<br /> nstallation wits serve: Residence
<br /> ' Apartment House [] Commercial ❑. Trailer Court ❑ Motel ❑ Other'$
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<br /> Number of living units: •CJ,-..- Number of bedrooms _�Number of baths........- Lot size .. ._.,
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<br /> .: Water Supply; Public system❑- Community system 1:1Private(9"t)epth to Wati'Tcole-,$0.-ft~` —�—j
<br /> Character of soil to a depth of 3 feet Sand E] Grovel❑ Sandy Loam Clay Loam [j Clay ❑ Adobe F-1 Hardpan ❑
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<br /> Previous Application Made: (if yes,date_i..''`.._... _..._.. I No� New Construction: Yes [❑ No FHA/VA: Yes ❑ Na
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS: w -
<br /> ----(No•septic tank-or-cesspool-permitted if public_seweris•available-withiiT�200 —
<br /> A Septic Tank: Distance from nearest we i_-•---_._.!„•:..Distance from foundation.,...................Mateeiat.................
<br /> �xas,�s�s?G No, o- compartments...---•.........:.....:..Size ._...._.....:.... .,-----Liquid depth_........ ._... . ... Ca ac;t
<br /> Disposal Field: Distance from nearest well......-.._-`..J.Distance from foundation._.-.-_.:..........Distance to nearest ]of line-•
<br /> ❑ Number of lines...._....._,.............. Length of each line ...___.Width of trench......------.....................__
<br /> Type of•filter material.....................`....Depth of filter material,....-..
<br /> ............... Isngtil_............_..•--.._._...._-..__._.__...
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<br /> Seepage Pit: Distance to neare t` ell..n'�rL(1._._.. Distanc rom u^dation.,._.
<br /> ° _........�0,}'st ;iip to rearest�t line.' (��J...-._
<br /> Number of prts.. .t .... _...Lining material.. .. SiT.E: Diameter..'.`... ......... .Depfh. : . .7
<br /> Cesspool: Distance from nearest.well................Distance from foundation.........._...... ..Lining material...........................
<br /> ❑ Size: Diameter-,. __...._ _ .. ...........__.Deplh...._.............____.....,......._..._.__.-......_liquid Cap acity........_,__..,_.,........_gals.
<br /> Privy: Disfance =rom nearest well.................. ..
<br /> Dista^ce from nearest building..........
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<br /> Distance to r,earest.lot,line........
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<br /> Remodeling and/or repairing fdescribe):i_...
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<br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County
<br /> Ordinances, State laws, an d regulations of the San Joaquin Local oiaaith District,
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<br /> --..... -. ..�3. ._ .. ...... t .(...(Owner and/or Contractor)
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<br /> {Plot plan, showing size of lot, loeationof system in relation to w, ils buildings, etc., can be place an reverse side}.
<br /> FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY-.-,.I +.. •..U......... .............._.,...... DATE_.....L..”_�r*r . _�-..te._ ,...... ..
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<br /> VIEWED BY...... - --_....• __..._._.........................,._.-_..._,- ...____.__...-.-...__._ DATE_.....,..._..
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<br /> flUILD1NG PERMIT ISSUED........ .. . _... ...._.__........___.__._,____...._.... ..__ DAT E-...........-.._._.. _...
<br /> Alterations and/or recommendations:............ .............. . .
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<br /> FINAL INSPECTi Y:�' /.1
<br /> Date__ M
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 14,11 E."o,olton Aw, 3110 West Oak Street 124 sycamore street '
<br /> 20.5 Waat 91h Street
<br /> Stockton,California Lodi. California Manteca,California Tracy,Colifornia
<br /> E.H.9 2M 1-67 Vanguard Pr<ss
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