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YUK UFFICt USE: -------------------- - -------------------------------------------------- ----- APPLICATION FOR SANITATION PERMITPermit No. . .. ----------- ------------------ ------------------ ---- - '{Complete in Duplicate} -------------- --- This Permit Expires 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. s�alication_is_made in_compGarce.with,C.ountyOrdinance No. 549. (_(p 2fv�_ t�i J��..S4 cedes-c�7rV.7 � JOB ADDRESS AND LOCATION."/ -_"- ,-�t.�- � xr �� ¢ --- � 'r ------ Owner's Name----- ,n1�s> h �f "4 ------ Phone Address-----------------AX �?��-l �`'"_��._ ----- --_--•------------------------------------- Contractor's Name---r ' r se •----•---- --------------- Phone------------------- Installation will serve: Residence 91 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: J.---- Number,.of.bedrooms Number of baths ----- Lot size _-- ----------------------------------------------- 3 Water Supply: Publics stem y y ❑ � De th to Water Table ft. ` f y ❑ *Communit system Private p Character of soil to a depth of 3 fe t:-zSand ❑ Gravel ❑ .'SandytLoam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------------- No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ --TYPE-OF INSTALLATION-AND+SPE' CIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well _%5 '----Distanc`fro foundation/q--____---"Mat real- --------- _�_ """ -- ---- No. of compartments--------- ------------Size'�--�tr-�t�-------Liquid depth----- --.- �� -------.Ca pacitY-••- Ct Disposal Field: Distance from nearest well.sS-P -----Distance from foundation----f Q.---------Distance to nearest lot line--- _'____ G Number of lines-t----.Al--------------------- Length of each line------V-A---_r4040 width of trench- q-`f_ � Type of filter materialA---�,-.---._.__Depth-of filter material"_ 9" ------.Total length----,/_F_ ',_ ._ 1 pits g � - ------------------ Seepage Pit: Distance to nearest well-___---.__-_.____ Distance from foundation____________________Distance to nearest lot line-.._____--_____. ❑ Number of -_Y------------ i ------Linin material----- -------- --- - Size: Diameter.- •-----,------ ---Depth ----- ------- - �---------- ..n.. ! Cesspool: Distance from nearest well______________"_Distance from foundation___-_.__-._._.__._Lining material__.___-_______"""__.___--------------- I _____, ❑ Size: Diameter I---------------------------------Depth-----------------=----- -- - al - - - ------ - ------Liquid Capacity------------ --------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--- -- ----------------------------------- i ❑ Distance to nearest lot line--------------------------•-•--------------------------- --------------------------------------------------- o Remodeling and/or repairing (describe):____-.-_---__--___-__ ---- -- ------------------------------------------------------------ -------------------------------------------- ------------ ---------------------------------------------- --- --------------------------------------------------------------- -------- ---- ------------------------------------- ------------------------------------------------------------------------ --------- --------------- , -- ------------------------------------------------------------------------- - - - Ihereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances. Statfe laws, and rules and regulations of the San Joaquin Local Health District. T z(Signed)--^ — " t " �� .._.- ---. Oand/or Contractor) Plot Ian, showin size of lat locatt , BY:------------ --- P 9 ---- - ---••-----•- --- stem to re �. y on of s 1 ------------------------ ------ --------------- --'-------_=""'�-`------_--------_��Y.=�•----}Title)------------- — ---------- -.------ �-- s y lotion +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCt - ------ - ------ _-------- --------------------------------------- DATE---�-- -�--`-�-��---- ----------- � � - REVIEWED BY DATE - - ----------------- ------------------------ BUILDING PERMIT ISSUED 1---------- ------------------ ----------- ----.- DATE_..- ---------------------------------- Alterations and/or recommendations:-----------------___----------------- ------------- -------- ------ ----•-- ---------- ------ ------------------------- -------•------------- --------------------------- ----------•------------------------- FINAL f NSPECTION BY:_- _ _ -__ ""_� —2�-C lye -G� Date - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street ;k 205 West 9th Street Stockton,California Tedi,California Manteca,California Tracy,California y: r.R.0 O.