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- F- - - _.- APPLICATION FOR SANITATION PERMIT Permit No. - -------- ----- -------- --- ------°.,-"-- om ! C t ( p ete in Duplicate} ------ --. I ;This Permit Expires 1 Year From Date Issued 'Date Issued Application is hereby made tothe San Joaquin Local Health District for a permit to construct and install the ''3 herein a Ted. 1 This application rs made in co the with County Ordinance No. 549. JOB ADDRE55 LO TION__+ -- ' aCt? I Owner's Name.-. «G ��. ------ -------- ----- Phone_----- " --- l - # _... - --------------------------- Address----------- Contractor's Name-------- •-•------ Phone Installation will serve: Residence_9Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.-4- Number of bedrooms _o _- Number of baths __�___ Lot size - _. 'k d _- I -----------•----------- Water. Supply: Public system ❑ Community system ❑ Private Zk'l5`epth to Water Table 2? ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamClay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Mader (If yes,date------ -------------) No ❑ New Construction: Yes,[-] No E] FHA/VA: Yes ❑ No ❑ Y is X TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) �j Septic Tank: Distance from nearest well----4:�O-,-pis#ante from foundation__ -- a a No. of compartmtents----�c-----------------Size_s __.e �----------Liquid depth--- "Z---------Capacity-- 7,�------ / ` i i f Disposal Field: Distance from nearest well.__�P�_.__._Distance from foundation__--ZQ------;Distance to nearest lot line__��.--__ [� Number of lines'!'__cZ--_______ -Length of each line___`rO`e----_______:__ .Width of french-.-,;? Type.of-filter material— _De.th_of filter material___o ��_- _-Total length_- �Q_ ----_:- P ��_ - -- r eepa Pit: Distance to near' well-- _-___Distance f m f undation- -.--. - � Distance to nearest lot line__apf------ _____ ❑ Number of pits_ _ _____________Lining material_ ___-$ize: Diameter_&,1,�.. } th---_ O ---------- Cesspool. . Di Lance from nearest well-______________ Distance from foundation.__._._.-_fJ:_---.Linin material ------------ ❑ Size: Diameter---------------------------- Depth----------------- { g ---- Liquid Capacity ----------gals. Privy: Di�tance from n arest well____ _ _________.._______.________---__D.istance .from nearest buildin building--------------------------------- ......... ❑ Distance to nearest lot line --------------------------------------------•--------�---' - - --------- ---- --- ----------------------------------------- Remodeling - ------ ------- ------------------ Remodeling and/or repairing (describe)_______ ______ i- - / }. f I f ---------------------------------------------------- -------•--------•-- ------------------------------------•------------------------------------ ------------------------- ... - =--•----------------------------------------•-------------------------••---- --- ---i--------- �y I hereby certify that I hve prepared f is a�pplica+ion and fha+ the work will fbe done in accordance with San Joaquin Coun+yC, ' ordinances, State laws—an-drulesan regulations4f the San Joaquin Local-Health District.-^ ----^ {...r F (Signed)--------------------- 1i -------------------------- ---- - -- r Contracfor) BY= r---:-- ----- Title----- ( ) � ----------------- - ------- (Plot plan, showing si a of lot, location o .syst��'em in r tion o wels,buildin� etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY N VI f APPLICATION ACCEPTED BY--- Y` k DATE--------- ------------------------- REVIEWED BY # - ---- --•-----------------------DATE-------------- I ------- --•- / PERMIT_ ISSUED------- - = ( DATE- BUILDING Altera+ions and/or reGpmmendations:__.__ �� y - _ ,� n� i _ { r ;w.; .._A �.�- ----- 4 --------------- ------ - --------------- ---------- - ------------------- ---------------- -- - • -------------------------------- --------- ----- -------------=•--------- ---------------- - FINAL INSPECTION BY----------- --- - ---- ------------------ Date �. -Y ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 ; 1601 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street, , s, 205 West 91h Street Stockton,California Lodi,California Mantecd,.Californ'ia L Tracy,California j CS 9 RCV15E0 8-59 3M 3-'63 F.RCo.