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FOR OFFICE USE: F _.___. V._"....._".__-.. APPLICATION FOR SANITATION PERMIT Permit No. __ _-.. I .____ '(Comple#e-in Duplicate) ------- --- --- - --- This permit Ex fres 1 Year From Date Issued 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, JOB ADDRESS AND LOCATION t/=----------6r av�,?x +Owner's Name--- -------�,.L(_(�_I7_ t Address- •----••--- `:_ I. ----------- Installation -- - _ - -.Contractors Name' --------- ----- ------ •--- Phone.--- �ZU�Y _ ----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.-i-._._ Number of bedrooms___- Number of baths _f____ Lot size __-` .__.__ "-.--___"__.______••- -- --- Water Supply: Public system ❑ Community "system ❑ Private)-<Depth to Water Table ------ _ ft i I, Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ 'Sandy Loam Clay Loam ❑ 'Clay ❑ Adobe ❑ Hardpan ❑ It previous Application Made: (If yea,dote_...---------- ]t�No`❑ '' New FConstruction: Yes ❑ No FHA/VA: Yes ❑ No E] i ' i TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No s ank or cesspool permitted if public sewer is available within 200 feet) i § " ' I is T n� Distance from nearest wefi__._________`-.-Distance from fbundaticn-----------------_.Material __.._._____.__.__.____-______-____._ _- �Fjl . of compartments...-- Size----- --- s= ' --Liquid depth--------- ----- Capacity " ---- i .i T ` saltance from nearest well ._:.._D'stance from foundation-_ . . . Distance to nearest lot line----- Nu _--__ 1 -- �, Number of lines. Length of each line_. P Width of trench _s. 4Type of filter materi Depth of filter materi /. sTotal length-_ - ------------- I ISeepage Pit: Distance to nearest welLZ-Vi---''-----Distance from fourldation .�_� Distan e to nearest lot line-_.___Q' Number of pts.__(_=._----"---._.Lining material.l�o-r .__. Size: Diamefer_.._._� - � Deptn__.___ ��.----___-----" ` Cesspool: Distance from n arest well _____________Distance from.foundation__---..._...____. ..Lining"material-.'___._.__.__..-__.._.._-.._____----- -----.Depth------------------------ ------Liquid Capacity--- •--------- gals. ❑ 5ize: Diameter. .- -- - ----- ------- --------- Privy: Distance from n`Barest _.....__" ._. _ _°_Distance from nearest_buildin g- -=`-------------------- (� I ❑ Distance to nearest lot line ------------- ------------------- -= - --------------------------- { IlRemodeling and/or repairing (describe}:-------- __. -- _ _- j' ------------------------------------------• I _ ------ --- --•-------G-- - �----- ------- ----------- ------------------------------------------------------------------------------- ---------------------------- - r------------ I hereby certify that I have prepared this application and that the A will be done in accordance with San Joaquin County State I ws, and rules and regulations of th n Joaquin Local Health District. j,ordinances, St r (Signed} ------------------- -- --- ----( Contractor) ]] �°. By:... (Title)-------------- -------- ------ - --- --------- (iPlot plan, showing size of lot, location of system in relatio o wells, buil gs, etc., can be placed on reverse side'. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - - ---------------------------- ---------------------------- DATE --• _ REVIEWED --- -- -- - ------------------------------------------------------------ 9-------------------------- BUILDING PERMIT ISSUED ---------- - -- ------------------------------ --- DATE---•--------------------- ------- ----------------• ---- --- -- ----- ------ ------- --------------- ------- ---------------""--=---------._ DA•TE'. Iterations and/or recommendations:-t---------------------- - --------------- -------------- --- - -- ---------- ---------------•------------------- -- = ------------------------------- - ------------------------------------------------------------------ - ................... --------- ---------------- ----- ------------------------- ----- ----- ----------------- ------ ------------------------- -------------------------- ------------------------- ---- --------- ---- ------ ---------- ---------- --------------- ---------------- -- - --- --------------- ----- -- -- -- - ------- ----------------------------------- I � I� I - o FINAL INSPECTION BY: L�'c�. * r� Date.-------- INSPECTION SA . N 0OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoiislion Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press