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APPLICATION FOR SANITATION PERMIT Permit No. - -- ----------- (Cor"PletO in Duplicate) Date Issued --3/(,/ This application - 1_1�_j Application is hereby made to the San Joaquin Local Health District for a permit to construct and install is made in Compliance with County Ordinance N 549 the work herein described. JOB ADDRESS AND L AT N 4 7 --- .6- Owner's Name --------- - ---- -- ------------------- ---- ----- - ------------- ----------------- �__ Address..... --- ------------- ;;;;,- ---------- 11Z---I--------------- --- ------ ------------------ -- -- ---- -- - ------------ ---------------- Phone,.-;w 214.1 le,K ----------_-------------- -------------------- Contractor's Name ---- ----- ---- .. .... Installation will serve: Residence Apartment House 0 Com-rn-e-rcia-I---0----Tra-iler---C-Court---E]----m-0- phone --------------- -- - -- Number of living units-, >,ber ❑of bedrooms 0Z Number of baths --- Lot size fel ED Other E] Wafer Supply, Public system Co,mu,.,fy system ------------- blecoff. feet: Sand El Gravel Ej Sandy Loam [] Clay Loam E] Clay El Adobe U?_<a1dPan El Character of soil to a depth of 3 fL Private Ej Depth to Wafer Ta Previous Application Made: Yes Ej No �New Construction: Yes E] No Ei4�FHA/VA; Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ (No septic tank or cesspool permitted if Public sewer is available within 200 feet.) Distance from nearest well-----------------Distance from foundaf;on--------------------Material No. Of compartments---------------..........Size eld: Distance from nearest well.----------- .Liquid depth---------------- ---------Capacity------- ----------------- Number of lines-------------- _Distance from foundation--------------------Distance to nearest lot I;ne Type Of filter material ---------------------Length of each line------------------------------Width of french Seepage Pi Distance to near t J - epfh of filter material--------------- -- --------Tofa) length SMw ------------------------------------------ Number of pit sfanc om, fo dation_. f Lining material-_ fo quo nearest to kiine a 4? Cess pool: 8Z-40tze: Diameter" / --------- D,pfb_._�_�-------------------- Distance from nearest well----------- Distance from foundation--------------------Lining material El Size: Diameter-------------------------------------Depth........ --------------------------------- Privy: Distance from nearest well------------------ --------------------------------------------Liquid Capacity-- -------------------------gals. r_1 Distance to nearest lot line -------------D;sfance from nearest building--------------------------- 7 V----1----------------------- --------------- 9 and/or repairing (describe ---------------------------------------------- ------------------- Remodelin ------------------- ------------------------------------------ ------- ------------------------- --------------- -------------------------------------------------- ------------------------------------------I-------I----- ---------------- ----------Z -------------------------------- --- --------------------------r----------------,.............. ------------------------------------ -- -------------------------------------------------I----------------------------------------------------- by certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e aws, and rule and re I 'ons Ons of the San Joaquin Local Health District. cr� rl"s 01 1 [Signed)---- -- -- By:--- ----- -------- .. ... ..... . - -------- - ---- ----------------------- -------------------------- ____ - /jOwner and/or Contractor) (Plot plan, showing size of --------------------------------------------------------(Tifljea lot, location of sYsfe i re afion to wells, buildings, etc., can beep aced on rev/ erse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWEDBY-------------------- ---------------------------------------------- DATE----- BUILDING PERMIT -------------------------------------- ---------------------------------------------------------- DATE ------------- I-�_4 ------ Alterations and/or recommendations:-- ---------------\� --------------•--------------------------------------- DATE-------' - ---------------- --------------- - -------- ------ -------- ----------------------•------ -- - --------- -- ------------- --------------------I----------- - ----- -------- -------------------- ----------------------------------I--------------------- ------------------- .. ...... ----------- ---- -•i7 ------------------------------- ---------- -----------------I---------- ---------------------------------- ------------------ ---------------------------------- -------------------V--------------------I-----------------------------r------------- ------------------------------------------------ -------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------- ----- ..... .......................... INAL INSPECTION BY: ` --- -.- j---------------------------------------- Date--- ------------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132Sycamore Street Stockton, California Lodi. California Manteca, California 814 North "C" Street Tracy, California 9-2M , Revises 1.57 F.P.CO.