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FOR OFFICE USE: w ----- --------------------------------------- --- _c .�� APPLICATION FOR SANITATION PERMIT Permit No. . �. __ -K� I' ------------------- -------------------------- (Complete in Duplicated Date Issued -----------------------------------_..__._._._.----- _.- This Permit Expires 1 Year From Date Issued 0-- 2�0 !' Application is hereby made to the San Joaquin Local Health District for a permit to construct and i al�the work her describe This applicafiion is made in compliance with County Ordinance No. 549. `'"4"'"- �� ® ' �- - x ---- JOB ADDRESS �C.A TION__`K __ - - one:"> � " rOwner's Name ----- Address---- ------ L?_ p `------------------------------------------ -------•-------------------• ------- Contractor's Nam -y _ ci y^t Phon �fi�-rrd. Installation will serve: Residence Apartment House �1, Comerc,a€ ❑�,:T_, ail i Court ❑ Motel ❑ Other ❑ Number of livingunits: _�..._._ Number of bedroom l s rnb�er of bafi __ -It size ------1�-0�?x....40 Q----------------�� �1 _ Water Supply: Public system ❑ Community system Private A r �Depthtto W' ter Table _____. ft. Character of soil to a depth of 3 feet: 'Sand E] Grave ❑r Sandy#,LSam �� Clay Loam ❑ Cl Y dobe❑ Hardpan ❑ Previous Application Made.• (If yes,date-----------------.rte No Eg Neli onstruction: Yes W o Ell, FHA Yes ❑ No TYPE OF INSTALLATION eANDoSPerml tted��ifou S G sewer-�s�availa�le�w.ithin_240 No se t'c to c s � ��r Septic Tank: Distance from nearest well _.r Ptanc�e from fou . Nf�aterial_ 3 nn . No. of compartments__Rj__._._.._-_ --.__:5ize,_��4-9 :Liquid de�th____+a -_� �Capactty_.C�- p Distance from foundat•i f Dis osal Field: Distance from nearest well_ -----_a r on*`,( '--_.__A.Qistance to ri arest lot line_____ '_______... Number of iines____� .. Leng of eachhline_/r �_____. ___-.Width of french.. r Type of filter mate Peptic of filter materiaL -----.-Total length_-___,f_ �--`--. ----- � Seepage Pit: Distance to nearest well_ -------------__Distance from foundation____________________ isfance to nearest lot line-------__..____._ ❑ Number of Psg m-�aterial-----------------------Size: Diameter-----------------------Depth- - -- --------------- --------- Cesspool: Distance from - nearest well Distance from foundation.......----------.-..Lining material___-----..-----------------__._______ Priv Distance from nearest well---------------'Depth-------------------------------....-----------. --Liquid Capacity--.----------------------❑ Size: Diameter--------------------- -------------- Distance�from nearest budding <, Privy: - - > > - 4 ❑ Distance to nearest lot line- -----------------=---------------------- - -------------------------------------------------------------------------------- �. Remodelingand/or repairing (describe):----------------------------------- ------------------------------------------------------------------------------------------------------------------ ---------------------•--------------------------------------- ----- --- t_: ------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------=-------------------- ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta aw an rules nd regulations of the San Joaquin Local Health District. 4_ _ P!_ ------------------- �f�ot Contractor (Signe t I Ill By:-==-------- _-_- -----=--------------------- - _� - �_-_-F - ----------�-*- (Plot plan, showing size of lot, location of system in rela 'a .,towells,,.buildings,„etc. can be placed on reverse side).,, FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY------'T7(-K-. ....'----- ----------------------- ----------------------------------=- -- DAT.E_._._._ �-r_�� `�"�------------- REVIEWED BY------------- ------------ ------------------ --------------------------------------------------•----------- ---------------- DATE - -------------------------------- BUILDINGPERMIT ISSUED'--------- --------------------------------------------------: ----------------------------------- DATE--------------------------I---------------------------------- Alterationsand/or recommendations------ - --- --- -------------------------------------------------------------------=-----------------------------------•-=------------------------------------- ------------- -------- ----------------------------------=-------------------- -- ---- ------------------------------------------------------------------------------------------------ -----------------:---•----------- - -- -------- ----- ----------------- ----------------------------------- ----------- -------- - --------------------------------------- -------------------------------------------- --------------------------------- y FINAL INSP-EC BY: Date....-__-.-- 7/- .-------------20------------ - 1*1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave, 300 West Oak Street X124-Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C❑.