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OR OFFICE USE: ` . .y_, -= <br />_// __ _-_.-__--__.._...-- 3iJ APPLICATION FOR SANITATION PERMIT Permit No. <br />(Complete in, Duplicate) / <br />.............. ....................:-.__._;_.----:-.... This Permit Expires'1 Year From Date Issued Date issued __.! - 6Y <br />Application is hereby made to the San Joaquin local Health ".District for a permit to construct and install the work herein. described. <br />This application is made in compliance with /County Ordinanc -No. 549, <br />JOB ADDRESS AND OCA ION ------- 4!. <br />------------ _ K------------ -................................................... <br />Owner's Name ......... l ;{ <br />- --- K-r--------------• .----- <br />�..... --------------------------- - Phone-----'•-------•------- ---------- <br />Address ...................{ <br />--� <br />Contractor's Name --------•------ - ->r -- -• one,, <br />t <br />Installation will serve: Residence Apartment House ❑ I Go n mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />Number of {iving.units: Number of bedrooms _c`_ Number of baths �_ Lot size .___- <br />:: <br />Water Supply: PublicEll system. Comm unit # x€ ' <br />Unify . s ystem ❑ Privafe'� Depth to Water Table.I�V_, ft, <br />Character of soil to a depth of 3 feet: Sand I] Gravel ❑ Sandi/y Loam ❑ Clay Loam ❑ Clay ❑ Adobe,' Hardpan ❑ <br />Previous Application Made: (If yes,datej'-?- `.1.-:_..) No ❑ New Construction; Yes •❑ No W' FHA/VA: Yes ❑ No ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br />O*Noseptic tank or cesspool permitted if public sewer isavailable within 200 feet.) Distance from nearest well_________________ Distance from foundation___-_-_-__-.-----_ Material..--..--:._-__.No. of compartments. ----Size-------1•••- -----•--_._•=---Liquid depth------------- - Capacity :_._:._._.. <br />r <br />s Fiel Quante from nearest well... .........:.•Distance from foundation -------------------- Distance to nearest lot line ......... <br />•Number of lines ------------------------- —._­-..Length of each line -----------------------_-...Width of trench_-_--- :-- ...---------•-- <br />'.• .� <br />Type of filfier.material_- _'-----r'rr Depth oftfiltermaterial ______________________Total.length ---------- _------------------------------- f <br />Distance to nearest'well_ QU___._._ .Distanc m f• undation__:.;%_ <br />� 8 .5____-.Disfiance to nearest lot line- `rJ...6.._._ <br />Number of'pits..___.1___..._____ Lining material / .Size.- Diameter..-�_ <br />/ r 1. £% �_J <br />Cesspool: Qistance,from nearest wbllz `'--.----__Wstarice from foundation_._____ --__.-___-.Lining material ........................... <br />❑ Size: Diametei{�"- :.Depot...-. - Liquid Capacity <br />p. _ 9 ........... :gals. ! <br />Privy: _ Distancefrom'! nearest well?­- ---------------------------- Disfante from nearest building.. <br />a r <br />❑ <br />Distance to nearest lot line_.- -•--- V --I -` <br />-- .... <br />- <br />Remodelin' and/or repairing (describe): -k <br />�. 9 / p g ( ).- •---------------- - <br />••-------- ---•------- - {:. � � � ��,.. j. .# <br />r • <br />i <br />t f <br />-=---------------------------------------•--•------------------------------- ----._,.__.- <br />l here y cer+i that -•have pr,epared this application and that the work will be done in accordance with San Joaquin County <br />ordinance aws, and r les and ulations d# the San Joaquin Local Healfh District. <br />(Signed)----- - --- -•• -- • - -- ---- --- - -- <br />----- .............. wrier and/or Coniractor) <br />.., {Title) <br />{Plot plan, showing size of.lot,.Ioca+ion of;S stemnrelati fo weifs, building's, etc., can be placed on reverse side). <br />.09 # i <br />_ <br />'FOR-DEPARTMENT USE-ONLY <br />APPLICATION •ACCEPTED 'BY------- - _ .f <br />� ` ---... DATE-.------ REVIEWED BY------- •--------•-----I--------------- ---- •----------_------------------ - DATE---------- <br />i3UILDING PERMIT ISSUED._ - .....; .- f- -. _. D� � TE... ._ �� � <br />- - <br />Alteration a d/or <br />A.. <br />--------------------------------- <br />--_. <br />r - <br />­------------------- - . <br />----------------------------------- ----- -......... --_................................... ------------..._.. <br />t.....__......................_-_....__. ---------------- <br />FINAL INSPECTION BY: ...... �-,_..a.5 - ------ Date r <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 f, Ho:alton Avg.€ <br />' 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />stockton, California Lodi, California Manteca, California Tracy, California <br />E5 `J REVISED U'SV 3M 3-'63 F.P.0 . <br />f <br />