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t-UK UFHCE USE: -------------------------------------- -------------------- --------- ----- --------------------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- --------------------- ------ (Complete in Duplicate) -------- --------------- ------------------------------- - This Permit Expires I Y Date Issued Year From Date Issued Application is hereby made to the San.Joaquin Local Health District for a permit to construct and instal[the work herein described. This application is made in lienee with County Ordinance No. 549. 12 coJOB ADQRE55 ANgLO ATm��Iiance C 01 ON. - ---------- - ------------------------ ----------------------------- Owner's Name-----A,,,, ------ -------------------- -- ---------------------- Phone-:,,------ Address_Z).,)�&_�__ ' _2,47 --Z 7 $ ----------- ----------------------- ----------------------- -C---------- -------- ------------------------------------------------------------ ... Contractor's Name--- ----- ------------------------------- ---------_--- Phone---- ----- --------- --------- `4" Installation will serve: Resignce [3' E]Apartment House Commercial [] Trailer Court [] Motel C3 Other - Number of living units: -------- Number of bedrooms ---- Number o -1-baths ________ Loi size ___________________£._______--__________ _ - Water Supply. Public system n Community system. E] 2i,,tVeepth to Water Table _!7=-"ff. /7-y - Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam Clay Loam' [] Clay E] Adobe E] Hardpan El Previous Application Made: (if yes,date____________________} I No' - Now Cori,fr cf;on: Yes No E] FHA/VA: Yes ❑ N TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool p4'rmitted if public sewer is available within 200 feet.) Septic Tank: Distance from ne ,rest well_____-____ _Distance from foundation-__ M��ai a I iNo. of compartM-9hT,.3 - _m4�.'.x__5'Si.............•----------------- ---Liquid dep�h----- ----�i --------Capacify.____920�:�------ Disposal Field: Distance from nearest well. -----Distance from foundation___:. Distance to nearest lot Ii7---k2_12'. Number of lines-A._____________________ ---Length of each Width of trench--7,--i�/--- Type of filter ma -- -------- /j- -- --------:------ --.-Depth of filter material- length.__J 2 -------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______-______- -" ❑ Number of pits-_J--------- -------Lining material---------- ------------Size: Diameter----------------- - ---.Depth----------------- 11 ------------- n --------- Cesspool, Distance from nearest weil----------------Dista 'ce from f6undafion------------------ Lining material ----------------- ------------ E-1 Size: Diameter------------------- -- ----------------Dept h als. ------------------------------- ---------------------Liquid Capacity--------------------- T, -------g —Dista-nce-fr6-mnearest'well-------------------------------------------------Diisfance fr&n nearest buMing------ -------------------------- -----_ El Distance to nearest lot line--------- --------- -- ------- Remodeling anO/or repairing ,4- --- ------ -Z� ----- ---------- -------------y ----------- ------ ----- -- _Z-----------�4,4_ .. .....6_�-- ------ ------------- --------------------------------- -------------------------------- ------ _Jrf-ify that I have prepared this application and that--fhe-.-wor-k--will--b-e--Bane--in--accordance--with-San Joaquin County I hereby c ordinances. State laws, and rules and iregulations of the San Joaquin Local Health District. (Signed)--------A- ------------------------------------------------------------------------------------------------------(Owner and/or Contractor) BY=B -- - ---------- - -----------------------------------------------------------(Tif le)---------- -- - ----;�4�x -------------------------- ------------ --------------- ................. (Plot plan, showing size Of lotjocation of system in,relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- L ------------------------------------------------------- ----------------- -------- DATE------ - REVIEWEDBY --- ------------------------------ ------- --------------- ---------------------------- ------- DATE---- BUILDING PERMIT ISSUED--------------- ' _/4 -------------- ----------------------------------------------- ------------------------------------- DATE----------------------- ---------------------------- Alterations and/or recommendations____________________-------------- ----- ------------------- ------------------------------------------- ----------------------------------------------------------------------- ------------------ ----------------------------------------------------------- ----------I-------------------------------------------------------------:-------------- i------------------------------------------------ •---------------------------------------------- ---------------------------------------------- ------- ------------- -------- ---- ------------------------------------------------------ --------------------I--=-=------------------------------------------- --------------------------------------- --------- - -------------- -------------------__ ....... ................-.Ij------ ----- ------ ------------ ------------------------------- --------- ------------------- ----------------------------------------- FINAL INSPECTION BY-------------...... SAN JOAQUIN LOCAL HEALTH DISTRICT A 1601 E.Kaxelton Ave. 300 West Cla.k Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,Cofffornia I Manteca,California TracYr California Es 9 FlEvisEo a-sq :3m 3-,63 r.F-.co.