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FOR OFFICE USE: ��--��-'7 -�-- --- ---/-fir.._ ------------ ------------ ------------------- --- ------- APPLICATION FOR SANITATION PERMIT Permit No. - =----- -------------- (Complete in Duplicate) Date Issued 1 -r - . ' - - ------------------_--- ",_. This Permit Expires 1 Year From Date Issued ` Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. pp 'incompliancey nce No.-549.` -- - ---------- This application is made with Count, rma� � JOB ADDRESS AN ---- - ---- OCATIQN. _� Phon Owner's Name-' _ _ t - A 44 f� A Address -------- ------ -- 6 Phon ContracosName_ � _ -N , P. Installation wserve: Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ ill Number of living-units: of bedrooms _-- Number of baths __/--_ Lot size _ -- --1 ----•------------------------ Water Supply: Public system "X. (Community system E] Private ❑ Depth to Water Table {}- Character of soil to a depth*of 3feet:, Sand ❑ Gravel E] Sandy Loam El Clay Loam ❑ Clay ❑ Adobe N Hardpan ❑ _ 1 i . Previous Application Made: (i yes,da te___---.--_.." --I No ❑ 1 New Construction: Yes ❑ No K FHA/VA: Yes ❑ No , TYPE OF INSTALLATION AND?SPECIFICATIONS: � � E t (No septic fanklor cess poo permitted if public sewer is available wi}hin 200 feet.) Septi �j(i5� No�,of cam artmen"Ts--------------- -------Size-------------------. lundation_ -----•-------- -.Material--------------- ------------------ ------------- c Tank: Distance fropm nearest well_--_-.-_ -_-- Distance from f' 1 Liquid depth--_______________________Capa--i}y__.-___-____.---____._. �IVG ' •� � Disposal Field: Distance"fromnearest'weIL F� _#Distance froom foundatio�n---l-� Distance to nearest lot ---- - . Numbei of lines__-�t-� -rr -- n----Length of each Iine.gQ"_ _F___�r------..Width of trench... ------------ f>. I r T e of filter,material_ -. -Depth of filter material----J y-------.---Total length__tS. ------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--__._-_-------._--Distance to nearest lot line__.______.._-_.- , i, s � ❑��XISf� Number of pits material-;____________________�lze: Diameter_-_--___.__..- Depth t--y--- Cesspool: Distance from nearest well.___-_----_-_---Distance from foundation------------------_Lining material__.__- ________.-__. Size: Diameter---- -- ----------------- ------- --.Liquid Capacity----------------------------gals. ❑ -----Depth----------- i ' Privy: Distance from nearest well___________________`-----------.--------------Distance from nearest building-------------_---------------------.------ 1 . yli = ❑ Distance to n�rest`lo+� ne- - ---- ----- --- -------- ---•------------ --•--------• ---------------- -- ---------------- ------ ------------ r.�...._...� //.. (�] --------------------------------------- - --------- Remodeling and/or repairing (describe :---- - ----------------------------- -- i - ,0' 3 --- ------------- ----------------------------- I i --------------------- -------------- ---------------- ��T'`�tiw-y��wi"v ------------ - -- - - --------�- ilhat e work will be done in accordance with San Joaquin County I hereby certify that I have prepared this aicatonan ordinances, Stat " and rules and regulations of the'San Jaa uin Local Health District. Loc -------------------------------------------- Owner and/or Contractor r (Signed)----_------- • __`'t . . ( ) i --- ---- - -- ------- ---------- -- BY:---------------r--� -- --- - (Plot plan, shaving size of lot, ycation of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY .�. G� I APPLICATION ACCEPTED BY ------- - - ------------------- --------------------------------------r DATE----- --Z l------------------------------- REVIEWED BY ------------/.--,,DATE------------------------------------------------------------- REVIEWED - -------- - - BUILDING PERMIT ISSUED-------------------------------------------------------------- ------- DATE Alterations and/or recommendations------- ------- -------------------------------- -------------------------------------------------------------------- -------------------------- i - I ----------------------------------------------- - --------------------------------•-------...------------------------------------ --------------------------------------- ----------------------------------------------------------------------- --------------------- } Date----- �. _ lu-(� - ---------------------------- FINAL INSPECTION BY:. ' - SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.