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FOR GFFIGE USE: ----- ------------------------------ ---------------- P' ralit No. y ---------- ------------------------------ ------- ----- APPLICATION- 1=0R SANITATION PERMIT This Permit Expires 1 Year From Date Issued Date Issued �._ b- ------------------ --------------------_____ ____ __ (Complete in Duplicate) - ------------ ----- P ,�.4 t Application is hereby made to the San Joaquin Local Health District for a permit to construct and Inst�l�tri� wo herein described. + This application is mad to compliance with C_opn dinance.No. 549. 51 D� t J��I LOCATION �F _ D ' ` _ ---------6--- ��)� too l- o . JOB ADDRESS ANQ - Owner s Name------ --------•---•-- ---------- -------------- Address _ �- 23 ---�-- ----- -------------------- -------------------------- - Contractor's Name---- Trailer ,n Phone. .. - - - it V_._:__ Installation will serve: Resident ET Apartment House ❑ Commercial ❑ Trsiler Court ❑ Motel)❑ O er=,❑ , - -'- Number of li in units. -- Number$f bedrooms _._ Numbe of bathe L�otsize _ X. DQ----------------------------- g - _ ft. Water Supply: Public syr;fe"❑-1MCom—nVin�y-system rE Private �epth to Water Table __ 5 CGravel�❑ Sandy Loam.❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Character of soil +o a.depth..o#�3.fee+ ,,a andyY ., --Previous-Application Made: (lf yes,da.te. P )No New Construction: Yes.�o []..:-FHA/-VA:_Yes-E] No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 p p� p va�la6ie within 200 feet.) li 5e tic Ta .k: p Dista ""-_•. • Q_-----..Mat rial_._R �_Z'I<fl----- ---_-Q--- "i No se tic tank,or cess ool permitted if public sewer Is a Distance from nearest well__�__..___ D1Zean e from foundaton____ P� t 3 ,1�F y No. of compartments----- ------ ----- f 'Q Liquide.de�fh__� ------------ : �«�_ Di-stance.to nearest lot li e.-- -___..__. Disposal Field: Dilaance from nearest well,__-�O.....Distancefromfoundation_ =_ - T k e.lof filter materia-r,_� .-Depth off filter mlateriia-©?VCY�_otalI length--C�___ �..--------------- -•- Number of lines__-.-__- I��.� �#� .4 l_ I-�s Seepage Pit: 'Di tance to nearest well..__-----------------Distance from foundation`__.-______-_.___.Distance to nearest lot line._---___-----_._- . ❑ Number of pits-!-------------------Lining material---------------------.Size: Diameter Depth l r Cesspool: Distance from nearest well----------------- from foundation._._...............Lining material-----------------------__------------- Q ElSize: biameter---1------------------ ---------------Depth- --------- --------------------------------------Liquid Capacity gals. VOA Priv Distance from nearest well------------------------------------------------Distance from nearest building--______.___________------------------- E❑ Distance to nearest lot line--------------------------------- ------------ -----------------•-------------------- ------------------ - rt ` ----------------------------------------------------------------------- Remodeling and/or rr repairing describe ------•------------------------ ----------------------------------------------- Ii ------- -------------------------------------------------------------------------- -- ---------•---- ---------------- --------=-------- ----------------------------- -p-a� .�_ .. - ` `-E ------------- -------------- -----------•--------------------------------- :... ... r ------------ ------------ ------------------------------------------------------------------------------------------------------------ xs -- T I hereby certify that I have prepared this application and that the work will be done in accordance vffh Sa azauin-how ty ordinances, St laws, and rules a regul do s of the San Joaquin-= LocalHealfk District. �: _ - _ -- -�-- - eland or Contractor ( 'I BY ------------------------------ - -------------------(Title)---------- ......... ................................ ------- (Plot plan, showing size of lot, location of system in relation'to wells, buildings, etc., can be placed fon reverse side). FOR DEPARTMENT USE ONLY V1 1 --�� [� DATE... /C� !L APPLICATION ACCEPTED BY----- • #�------- ------------------------------------------------------------ { - -------- REVIEWEDBY--------------------------- ------ ------ ------ DATE----- ---------------- ----------- BUILDING -------- BUILDING PERM ITw ISSU ED==' :�== =-a = - -_=� ��==� -= == _ ==DATE-------------------------------- -•-- w ------------------------ Altera+ions"and/or recomme ations:........... .. ... �- --------- _ - - -----------�-_ ------------=------------- -------------- _ 1 5 `~ I\sC :. �n(r_ J-tf�--------------�T -1 -_; �_-------------------------------------- f ------------------------------------------------------ ------ - -------- ----------- FINAL INSPECTI. N B Date.------- " �. .�'S --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California 4 F.P.CC. k