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F R,O/FFICE USE; ,(��e,�,, f 5 -------------------- ---------- - ----- APPLICATION FOR SANITATION PERMIT Permit No. .� *.. ......_-3 ----------------- --------- ---------------'---------'"."�.'" "'"` .,� (Complete in Duplicate) �. _ 'Date Issued -------- ____ __ ___ This Permit Expires 1 Year From Date Issued T 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. I k 7 4 - / JOB ADDRESS AND`LOCATIOND l--�- k J� --� � ti'•��r!'r!Phone...---------;-------=--=---------- Owner s Name-- ' Address = - ---••-•---------•--------- 9------------------- D: _ Q Contractor's Name = L`} --------------•-------• --•--. Phone -----•• ❑ ❑ f �� i Installation will serve:' Residence ❑t Apartment House ❑ Commercial Trailer Court Motel Other Number of living units: __._____'Number of bedrooms -------- Number of baths -------- Lot size ____. __ - ----- "-•---------- - Water Supply: Public system ❑ Community system El Private F] Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dy Loam ❑ Clay Loam C] Clay E] Adobe�ardpan E]Previous Application Made: .(If yes,date.___---------------) No jNew Construction: Yes' No ❑ FHA/VA; Yes ❑ No F F TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or,eesspoo) permitted if public sewer is available within 200 feet.) °�} t AkI.1 Seistance from nearest well-.-____._..__-__Distance from foundation____________________Material________.______-_.______._._-____.___...__----- o. of compartments. Size Liquid depth Capacityistance from nearest w __--__.__.Distance from foundatior __.Distance to nearelot.li e__tumber of lines____ ___.-.- Length of each line ----'------Width of trench_____ �___-....___._______-__ ..�. ype of filter materiI:_� � Depth of filter materia'_ _�----- ----Total length--- °�� - 1- i i -- See Pit: Distance to nearest well.._�OR-__:::__Distance om foundation_/�b__`----___.Distance to nearest lot line_____..:_._.-._ i -- �j Linin material:_-I__---G-'�---'.Size: Diameter-____ ._. __r.......Depth__, ' -------------_.__J p nearest well________---___.__Distance from_foundation--------------------foundation Number of its:_�_�__.-__.____ _ __ g Cesspool: Distance from } aLining material__..____.__.-E*___.____________..__ Size: Diameter--------------------------------- tiDepth--------------------------------------------------Liquid Capacity---------- -------gals. ❑ IIC Privy: Distance from nearest well-___-----------____--:________-_.__-_.----__Distance from nearest.building_________________:___--_______.__-___... ❑ Distance to nearest lot line----------------------------------------------- -------------------------------------------- ------ 1 Remodeling and/or repairing {describe):---- ------------------------------ ---------------------------------------------------------•---- [ ---•i-------------------- I --------------------µ•-•---------------.-----�;------------- ------ - ------ ------- -------- ---------------- ----- .., _ ---- ------ - -- -- ------------------------------------------------------------------------------------------------------ I hereby certify that I have prepaied this ap,,pli�atio nd that the work will-be done in accordance with San Joaquin County i ordinances, State Taws, and rules and regulations f th an Joaquin Local Health District. (Signed) ---------` ------------- ------ I----------=rt--=---- ----(Owner and/or Contractor) --••--------------- ------- BY= 1 -- ---------- ----------------------- = (Title) -- ---•----- -- (Plot plan, showing size of lot,..0 f s i in relation/to wells,buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY € APPLICATION ACCEPTED BY-----, - ------------"------------------------ DATE._ _ _`r1_431 ----------------- ' --- - DATE REVIEWED BY----------------------------------" DATE-- ----- ----------------------- BUILDING i PERMIT ISSUED___________________ _______---- _ Alterations and or reco mendations:_____1. - _ /�- �i ,ft�c*�-"+ • ---------------------- ---- - --- 7`'( n --------- ----------- -- -- - ----- --------------------- -------- --- -- - -._.•- - ---- - --- ------ -- ---:_::==--C ..:: _ . -- -- -- - WFINAL INSPECTION BY:.--�� - ------ Date_..___ 3------- . Lam... �° SAN JOAQUIN LOCAL HEALTH DISTRICT ? 1601 F.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street k Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M