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FOR OFFICE USE: ..:f �.: APPLICATION FOR SANITATION PERMIT Permit No. ._ .' .:. . -a. -_ (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued ,l 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. 77 JOB ADDRESS AND LOCATION---------_�__�-- - ..........------ ............... 6hA,�----------------------------------- Owner's Name------------ s (?1rL?4=,-/e_�----------------------------------------------------------- -------- Phone_. t e Address---=--•---•-------------------------------------------- =�------------------------------------------------------------------------------------------------------------------� 4-----• Contractor's Name--- � � �1 / ��-------_W. •'r ------- -------- ------ Installation will serve: Residence De Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ iOt err❑ Number of.living units- -------- Number of bedrooms -Z—- Number of baths^_1_ Lot size -------l4 c=----__------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E-' Clay ❑ Adobe ❑ Hardpan ❑ t ' .__Noy Previous Application Made: lit yes,date_-------------------I No [� New Construction; Yes W/No E] FHA/VA: Yes ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well-/, Vl�*' Distance from foundation-Y-�-'--/-------Mater jl-_--464! r------------------------- f No. of compartments -Size___.- _. _ -----.Ca acit ��_.----.--_ ®� p �� - - ��-1- -Liquid depth -� p Y� Dis osal Field: Distance Number ofoline sear st well 0-4>.-" Le 9th of each I ne*e��-0,v_i.Widthc oft trench-s�Mine_--.-----__.----- r ance from foundationrr``r h fes`_.____"---'__' . Type of filter material - Depth of filter length_-/Pf2__0-___---__-__---------- Co Seepage Pit: Distance to nearest well-17,1--_-_____._Distance om foundation_ O --_-_--___.Dis ante to nearest lot lliine--_------------- [� Number of pits-------I-__-._-__--Lining material_ -/e-_...:Size: Diameter___!y_ .c��_..Depth--../_7-------------- N Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_---.: _---_.._-----_--.- 1 ------------ ❑..:: __ Size: Diameter.----;r---------------- ------Depth - Liquid Capacity ? gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building'"___:--""" ❑ Distance to nearest lot line--------------------------------- - ------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- --------------1---------------------------------------------- -----------------------------•-•--•-------------------•--------------------•-------------------------------------------------•--------------------------------------------------------------------------------------------------------------- --r ---------- ---- prepared -. -------------------- ------- -----.-- --- - ------- - ------ ------ I herebycertifythat I have 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. ql (Signed Q --_--_ Owner and/or Contractor ---- -- ---- BY;-- --- ------ -------- ------ -------------------------------------------------•----(Title)--------- . .--- (Plot plan, showing size of I9f, location tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------AV ' -------------------------------------------------- DATE----------Z-!r- !2 - -- ----------------- REVIEWEDBY-------------------------------------------------- -------------------------------------------------------------------------- DATE------------------------------------------------------------- r BUILDINGPERMIT ISSUED------------------------------ -- - ------------------------------------------------------------ DATE----- --------------------- Alterationsand/or recommend ations:.---------------------------------------------------------------------------------------------------------------------------------------------------•---------- -------------------- ----------------------------------•-------------------•-- -------- -------- .- - -.-- --------- --- ----- - - ---------.-. . ------- ------ --------- l /�� FINAL INSPECTION BY: C.� Date-----------------------------�_ __---. s� --------------------•----- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED B-59 3141 3-'63 F.P.CD. i �VVV