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FOR OFFICE USE: ' --------------------------------------------------------- --------------------------------------------------------- APPLICATION ,FOR "SANITATION PERMIT Permit No. ram.a� ------------------------------------------------- °... (Complete in Duplicate) Date Issued ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued 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. 549. Ziz-- 1?,o -q 2- JOB ADDRESS AND LOCATION_�sth-- z)4 irmy W1V:%#?4---a3---- c----_`��6)Q?*_- ---- I-----_I--- ----------------- Owner's Name---------------- -- . ------1mai`�.-p5------------------------•------ -------- ---------- . Phone----- ----------------------------------------- Address---------------------- .........7'_16,60-----Hammy-------------------------- Contractor's Name-------------- ._S�iv ------------------------------------------------------------ --------------------------------------- Phone--------------------------------.. g Apartment House Courtonntelhh❑ Other R'�°�i31'G� InstalleNmber ofrlein Residence unittsn-_--umber of bedrooms Numberofbaths Trailer Lot size ------------------------------------- 41. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table J_0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy`Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2-Iffardpan ❑ Previous Application Made: (If yes,date--------------:-----} No New Construction: Yes ❑ No �;FHA/VA: Yes ❑ No E� TYPE OF INSTALLATION "AND SPECIFICATIONS: A+PJTJOI'v CSF WST. R"s 'M C40ZLy (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---2_I .__ Distance from foundation____.P--------material----- 'fc'�----------------___ @� No. of compartments----_--.---Q------.-----Size----___'4�__S.x_�..__:Liquid depth___--_91--__----.._Capacity.. 860-9b/. r i - Disposal Field: Distance from nearest well--PCO ___ _.Distance from foundation_____PO________Distance to nearest lot line_ f ,_____.______-.. {� Yp i Length of each line Width of trench ------------------------ Type ---------------------- -J p� r �! ` . T e of filter material_ r +4aG�k-----Depth of filter mater�al_._.�1�-..._____.Total length--__--_-I1 .:-_--_____-_--__--__.- + Num er o Ines----------- µ Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line-_-_-_---__.--_.- \� ❑ Number of pits----------------------Lining material----------------- -----Size: Diameter----------------_..----Depth----___------------------ --- - i. Cesspool: DiOance from nearest well-----------------Distance from foundation Lining material-------------------------------------- �r ❑ Size: Diameter---- ------------------------------Depth---- -------- ----- - - - -- ---Liquid Capacity-------------------- ------gals. Distance from nearest well -_ Privy: --------------- _. .__-__ Priv : ___._Distance from nearest building--------------------------------------___ ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------- ----- --------- -------------- $ 'ng [describe):b s---- fi t11f c r.l� wj----�m lY= f .- -j 'P iv �s--- Remodeim and re a�ri f a' tc>!►sx7�? _ i b� ._.ct __ R��. �� pax. , s- _-- ------------------- ---------------------------------------------------- -----------------------------------=---------------------------------------------------------------------------------------------------------------------------------------------------------------I------ -------- . ----------------------- - -------------------------- ---------------------------------------------------------------------------------------------------------------- I hereby certify that I 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. r, .l (Signed)------------------- -- !I---------- --- - ------------____-. {Owner and/or Contractor) i By = (Title) (Plot plan, showing Yeof lot, location f ys+em in relation to wells, buildings, etc., can be placed on reverse side). ;I s FOR DEP TMENT USE ONLY APPLICATION ACCEPTED -� ----- ------ ---------------------------------------- DATE-----�'- -- --- `-------------------------------- REVIEWED ---------------- ---REVIEWED BY--------------------- -- - BUILDING - ------------- - -- - -- - -------------------------------------------. DATE----- -- ------------------------------------------------- BUILDING PERMIT ISSUED ----- ----------------------------------------------------- ------------------------------------------- ifDATE-----------•------------------------------------------------- Alterations and/or recommendations: --------------------------------------------------------------------- --------------------------------- ------ - -----�"- ------ - ---------------------------------_-.---___.__;k----..-_-.------.._.__--......-----_.._------.._-._----.._.-___.---.-----.__.-._..____ ._ ----_----------------------------------------------_----_- ..__.•..................................................................................................... ------ ".".-.------.-------.-----------------------------...__..------------------------- ----------------- -------�j----------------------- ------------------- -----------------------------._ J ,. FINAL INSPECT[O BY• }1... Date...... --------------------------------------- JOAQUIN LOCAL HEALTH DISTRICT i - 1601 E.Hazelton Ave."! 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Callforn!a Lodi,California Manteca,California Tracy,California F.F.Ca. ••'-