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FOR OFFICE USE: -------------------------------------------------------- " ...R.d_ APPLICATION FOR SANITATION PERMIT Permit No. . ---------------- -------------- ------- --- - --- This Permit Expires 1 Year From Date Issued { P Duplicate) Date issued 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. �A1 fir!i 3_.�p _7 JOB ADDRESS AND ON _ Jp--+---------!- --. � ._ _ _ Owner's Name LOCAT /'+� ! ---------- -- - Phone - -- Address ::` _.r ... t �°_ �,�`_ «� , , -- ---- . r' �1�-- ---------------- f-_--------------------- Contractor's Name--• 1�-A_ ':_9,A__S.14-------- . Al .- I -----------�---------- . Phone__ �^5� �� Installation will serve: Residence ❑ !Apartment House ❑.g. Commercial E] Trailer;' Court ❑� Motel E] Other ,e Number of living units: _.�----- Number of bedrooms _��_-_ Number of baths r,._-;Lot size __/A•._.. � _ � --- Water Supply: Public system E] . Community system❑ Private YDepth to Water Table — St I,I Character of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ❑ Hardpan ❑ � Previous Application Made: [If yes,date_.- ....... l No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: } k p {No septic tank or cesspool permitted if p"ublic sgewerr is available within 200 feet.}` t Septic Tank: Distance from neo est welli_ 0 ___Distance-from foundation- __--___.Material _Qwm _��__ -__-___._. rNo. of compartm'ts--------------------- --Size. ------ ---------I-Liquid Pdep-tf-- ---- ----- --=- - Capacity------ ---�--—---- Dis osal Field: Number from lines.-j1##_.narest well-, Distance from foundation_- --------Distance to nearest lot line--�.___.-.__.__ of f I' T e'of filter mata� _. Dethoffflter�mfateria!__�-_ - -- .Width of trench._��______ _ __-_._. Length "�° " ' ' Total len th_ ' .--Lining material_�ll _ _. Size: Dia Seepage Pit: Dista`�ice to nearest'well- __ _.____Distance from-foundation ________Distance to nearest lot line___t��° i 11 Number ofpits--2.------------- --�. - 1r �� ----Depth_ g .�, meter P Cesspool: Distance from nearest well.----...._.---_-Distance from foundation......!�--------- _.Lining material______________________________________ Size: Diameter. .-❑ *------- ----- ----------------De th--------------.------------s......- - - -__Li uid Ca acit __ als.p _Distance,fr � . q P Y--- ---------- ---------- 9 Privy: Distance from nearest well------=-------------------------------------.._. -___� -_` i #m-�nearest�building---------------------------------------- - -Rem❑ Distance to nearest lot line_._____.._._ --_-------- Remodeling odeling and/or repairing (describe):----- --- -- - .------ J . r ----------- --= _`-F_ :_ _..----- ----- y �_ i 4 _______________________________________}__________._-_._.--------------._ _ ._.-__J___--_.___. __2__ ___�__ ----------------------------------------------------- --__--_--_____ -__________-_--__-______-___-____-___________-___ __ �sy-__ __ - d M� ___. R._._II_ _. _ _ _ _ ' _____________ _________ ________n__� _ -------------------------------------------------------------- _ _ ___________ I. ----- ... ------------------------------------------_---__-_i- ave red this ication and that ordinances, andhr !es and aregulations olf the San Joaquin Loca.IkFiealltheDilone in accordance with San Joaquin County _ - ---- - - - -- - strict. M. {Signed)------ ----- _ - .-------- :' (Owner and/or Contractor) By:--------------- i_•_ �`_ '_ a ,. " ` {Title) - _1 ------- ------------------ Plot plan, showing'sizeyof Io}, location of s stem in relation o wells, buildin s, etc., ca ( p g y g �n be placecl' on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ . .- 3------ - ------------------- ----- ------ I: DATE"._S_._7--4---7------- - REVIEWEDBY----------------------------------------------------------------- ---------- -------------------------------------- .'�_._.DATE----- ------------' =` BUILDING PERMIT ISSUED---------- - ------------ -------- ------- ------------------------------------------ - DATE Alterations and/or recommendations = ---------------------------------- ---------- ----------------- -------------------------------------------------------------- ----------- - --------------------- ------------------------------------------- -----------------------------•------ ------------•---- ------ -------- Date-.-. ` FINAL INSPECTION BY: ,G�-.- ll.; :------- -- - - --Z 7 - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore 511reet 205 West 9th Street Stockton,Califairtia Lodi, California Manteca,California Tracy,California E.H.9 2M 1�67 Vanguard Press