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FOR OFFICE USE: -' -------------- + Permit No. ----------------- f/ l� _ APPLICATION FOR SANITATION PERMIT -------- ------:- -- ------------------------------------ (Complete-in Duplicate) 4444 -----•-- --- 4 ------------ -- This Permit Expires 1 Year From Date Issued bate 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. _f TION.- £�_•- �40W�---- a--�- I�C --- JOB ADDRESS AND LOCA - �� - 4444 Owner's Name----------- ----- --- .-0/,!;---/, �'-------------- - - `Phon 3P�V�x Address-------- —�3-�---�---- -------------c:----------------- Contractor's Name------------ `--�`a- s_ 4444 R- -- ----------- ---- Phone------ Installation will serve: Residence ®---A"partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -- Number of baths _1<0t size ., .1 f Water`Supply:`Public system ❑ Community system ❑ Private Depth to Water Table ------ - ft Character of-soil to a depth of 3 feet- Sand ❑ Gravel E] Sandy Loam (Clay Loam E] Clay ❑ Adobe E] Hardpan F] Previous Application Made: {1f yes,date................... ) No ❑ New Construction: Yes ❑ No 15,�'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) v S�Ta - Distance from nearest well-----------------Distance from foundation-.------------------Materia4 -----------------------------------.....-------. No. of compartments-- -- -------------------Size----------- -------- -----------Liquid de th--------- ------- -------.Capacity....-- ---------------- i ` r sal eft Distance from nearest well.�0.-----Distance from foundation --1..............Distance to nearer} lo}«e-- . r t Number of lines------ 444.4 Length of each line--..--�0-._...------.Width of trench. .2-4A tt 4444 - .-.De th of filter material..-.---f ___.Total length----------------------�?-.0--------.- �-------�4444 'rf f ,t� Type of filter material_ - -.. p S Pifi: Distance to nearest well. -5 .__-_---Distance,�from�gfoundation.- .__.--- Distance t Barest lot �j � Number of pJs---1----------------Lining material---E-4 f--.--- Size: DiameterA.-79_-� epth 4p a'- -444.4_ Cesspool: ) Distance from' nearest well ----------------Distance from foundation- --Lining material_...-.--.----------.----.-------44.44 ❑ Size: Diameter- ------------- -------- ------Depth------------ --- -----------------------------------Liquid Capacity----------------s--- -----gals. Privy: Distance from nearest well.-----.------------------..---------..........---Distance from nearest building---------------- _--------- ---._. ❑ ..-•..,.D tante to nearest lot line-------- ------"------------------------ --------------------------- --------------------- ----------------------------------------- Remodeling and/or' airin describe :_---- f---- - `--"-- ----------------------- g � _ P 9 (describe) d � -- ._- �------------•--4444-- - •- 6 4444- =4444----------------—---- . .. 4444 - --- -- -- !- - --�------I---'--------------�---'• -- -- --- ''4444--------------------------------------------------- ------------------ ----------------------------------------------------,- 4444 ---4444-- -- --------- /'--- ------ S -------"--------------------------i-4444---------------------4444-- -----------4444- --- -------------'---4444----------------- ----------------------------------------------------------'--------------------------- I her y_cer#:fy thettl have prepared this application and that the work will be done in accordance with San Joaquin County ordinafteA, State laws, a d'rules,and•reguiati s of the San Joaquin Local Heal District. (Signe —L/Lrca - - ----- ---- --•------ ------- (�Contractor) B ------------------ ---------- -- = ,�✓ _ if " - - (Plot plan, showing size of lot, location of system in r at on to wells, buil ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_- __ �- - -- --- --- ----------- --- ------------------------------------ ---------- DATE------&77i_/- -6.7--------------------- REVIEWEDBY--------------------------------------------- ----------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------•-------------------------------------- DATE---------------- ------------------------------------------- Alterations ---------------------------------------------------- Alterationsand/or recommendations:-------'- - ---------------------------------- ---- --------------------------------------------- ------------------- -------------•--------------------- -------------- ------ -------------"---------- --------------------------------- --- ---------- -------------------- -------------- ---------------------------- ----------------------------------- ----- --4444-- ------------4444- - - ---------------•-4444-----4444-- - --•------- ----------- -----------4444•--4444---4444-- ----- 4444-----4444- ------------ - - - -------4444-- ----------------- ---------------------------------- ----------•- - I.--....... - ----------------- --------- ---- -------------------------- ------------------------------------------- --------- ----_--------------- ------------------------ -------- 444.4 •-----.-.--4444-- -----------------. ...4------ --- -._��:•-- --- -4444-- °-•- -° - 4444 4444 -----.-4444-- - - - --- ---------------------------------- FINAL ----- ---•---44 44----4444-.CP: FINAL INSPECTION B 4444 ---- --- - ------ ----------- Date. ---------- - -- - --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Californla Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press -y