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--------------------------- - ------ ` ------------ -------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --- ---- --- -------- ------- ------- (Complete in Duplicate) 2 This Permit Ex ires.� Year From bate Issued - -------------- Date Issued --- - San Joaquin Local Health District for a permit to construct and i all the work herein described. Application is hereby made to the This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L ?ATION-___kms - _Q A( _ U -------- ------------------- Owner's Name----------- ---aiRl;CIS ---A-K,s 4?A[ ------------ -- -- - ............. -- _ _ --------------------- Address . . Phone --.BOx----- Contractor's Name-------0_Ir1!_N_ii=1�k ------------------------------------.---------•------------------------------------------------------------------------------------------------ ---- ------------------ ----•--- •---- ------ Phone---------------- Installation will serve: Residence f�Apartment House,❑- Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _ _____ Number of bedrooms ;;="Number'of=baths ❑ I Lot size ____ Water Supply: Public system ❑ Community system E] Private! e th to Water Table Character of soil to a depth of 3 feet: Sand (Gravel ❑ Sand4e�Loam ❑ Clay Loam Clay a Y ❑ y ❑ Adobe 0 Hardpan [� Previous Application Made:. (if yes,date._____..____-__.) No New Construcfion: Yes e--No ❑ FHA/VA: Yes Ej--No TYPE-OF-a-INSTAL-LATION-AND�SPECIFICATIONS: -- �y '{No sep}ic tank or.cesspool permitted if—publics'ewer is available within 200 feet:) �� — n Septic T k: Drs+ance,from nearest well .�-- �__----Dist_a_nc from foundation__./V---------Ma teriaL__e---._0_ /VCR�_____ -- ---. en _ Liquid de .th____ _ apaciylT CDisposal Field: Distance fromnearest weC --- z --- Distancerom oundation-__l�.-____--Distance to nearest lot line____5- I ; Number of lines-------- = -----------------Len th of each line__ --i--------Width of french - E c - ` Type of filter material9`_ ._ __-Depth of filter materiaL_._.f -- ` r Total length Seepage if: Distance tof pnearest w -_ ,�_---Disfance from foundation----/ 5 ____..Distance t nearest lot line-----_-______..� Number ofs ................ LiniRV let n material___ _ -SizEtDiametsr__.!1--Xd Depth // � - g Cess ool: Distance fFom nearest well_____________ Distance from;�Pftp�foundaf'ion ;Lining'material:4._._.______________ P ❑ $17e: Diarr9eter__.------------------ ----- --- +_Depth------�f ��..r ------- ----------- - -----------------Liquid;Capacity---------------------------gals.. Privy: Dist ce from nearest welt----------- -------- ----------------{�-------------Distance from nearest building _-_- {❑ Distance to nearest lot line.----------------=-- - --- .----•----.-•----- --- Remodeling and/,b, repairing (describe)---------------------------------- - --- • ". -- -------------------------------------------- --------------r - -- ------------- - ----Z- ---- ---- - - t -------------------------------- .-# �t_�__� fav i - P P Pp - - k I I hereby certify that I have prepared this application artd that the wor will be done in accordance with;San Joaquin County ;I ordinances, State laws and rules and re Mations of the San'Joaquin Local Health District. (Signed)------ ------`( !/ - — —-_ ------- { I _ wner�ansB or Contractor --•------- _. - Pot. plan, showing size of lot location of s stem in relation to wells, buildings, etc., can be placed on reverse side). Y T - ' _Y� f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTS L7 BY - -'..........---------------- - DATE. _:, Z---�� REVIEWED BY ------------------------0------------------- BUILDING PERMIT ISSUED_________ _____________ _____ Alterations and/or recommendations: DATE----------------- ------- # ------------------------- t ----------------- ----- -�9 6: --�...�pl�aG ~cs�,_. �- -- ------------------------- -------- 1 --- - --—-lam t -xt ----------- ---------------- ----------- cry---- -------------------------------•---- ------ ---------- FINAL INSPECTIQ BY:_ -- - - -- ------- Date......... SAN JOAQUIN LOCAL HEALTH DISTRICT # 1601 E.ko:elton Ave. 300 West Oak Street _ 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California -Tracy,California F.P.Cp, + ';