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FOR OFFICE USE: ------------------------- ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No, ---------------------- -------------------------- --------------------------- -- ------------------------- (Complete in Duplicate) Date Issued 17 `---�•---7 _--------------------------------___.----_._. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District far a permit to construct and insfall the work herein described. This application is made in compliance with County Ordinance No. 549. g Zpc�—If0`f/ 13 /II JOB ADDRESS AND LOCATIO - __.l'E}THR-Q ------ - -- �Q- Yk...--- --PF------ lR lr✓--c--`R` Owner's Name.--------- 9-F Q ------ -- - LF�L--I----------Fi_�.E- '��-------------------------- Phone Address------------------ - 9------Pj---C�:W10-01D-----------4 --A----------------`57-AA/--`.----------------..-. Contractor's Name---"�XDA-4-----=------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence B---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ---------- Other [I ` Number of living units:'- Number of bedrooms Z-.- Number of the _-/---- Lot size ----.� �_ --1 .---- ----- Water Supply: Public system ❑ Community syst m ❑ Private Depth to.Water Table-14- ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan 0 Previous Application Made: Ilf yes,date-------------------I No [KNew Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ --TYPE—OF—INSTALLATION—AND--SPECIFICATIONS: - - -— .'--=- ""`" -- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well--SP.------Distance from foundation----��--._----.Material._ -n�' �1~E� -------=------- 4 .No. of compartments..---. ��}} pp✓ wLI ---Liquid depth--.-- gr- ---------.Capacity--A?q�o-------- 1 4� Size--47/ VV Disposa 'eld: Distance from nearest well.-S.?�----.-Distance from foundation--k�----------.Distance to nearest lot line---5 -------- h line----- - Width of trenchr --------------------- Number of lines- _ y- -------.---Length of eac7 - 1 � ----Type of filter materiaL4-� � Z Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------.--------Distance to nearest lot line----------------- I ❑ Number of pits-------------- ---Lining material-----------------------Size. Diameter------------- - -------Depth ---------------------- ------ Cesspool: Distance from nearest well-----------------Distance from foundation---.----- ------..Lining material----------------.-------.------------ i ❑ Size: Diameter - Depth-------------------------- -- ------------------- Liquid Capacity- -------------------------- Privy.- _ gals. Prv Distance from nearest well.----- -------------------------------------- --Distance from nearest building_.-.------.---.-----.--------.-------___. F�e -:- y. � Distance to nearest lot line--------------- ---------------------------------------------------- ------ ------------------------ --------------------- -- -------- 010 Remodeling and/or repairing describe):------ v------ ---------- -------------- ----------------------------------------- --------------- ------------------------------------ - ---- ------------------------------------------------------•----------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun+rA ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ------ -------- ------------------------------------- (Owner and/or Contractor) i ----- ---- - ------------------ : � [Plot p[an;'showing size of lot, locatio ys+em in refa+ion to w Its, buildings, etc., can be placed on reverse side). FOR DEP TMENT USE ONLY i APPLICATION ACCEPTED BYr --� .-------- ------------------------ ------------------------------- - DATE-- 1- `�{ -- - -------------- REVIEWEDBY-------- ------------------ --------------------------------------- ---------------------------------------------- DATE ----- - -- -------------------------------- ----------- IBUILDING PERMIT 15SUED--------------------------------------- ------------------------------------------------ DATE----------------- ------------------------------------------= --- Alterations and/or recommendations:------------- ---- -------------------------------------------------•-------:-----------------------•----------------•------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- FINAL INSPECTION BY:. - __ 4�-c�` - - ---------------- Date----d_._ -= ------ -- ------------------------------------- SAN JO UIN LOCAL HEALTH DISTRICT r 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' Stockton,California Lodi,California Manteca,California Tracy,California f(ff/f1 F.P.CC. r i