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R OFFICE USE: --- -s - f ; �____ APPLICATION FOR SANITATION PERMIT Permit No: ..1 _ ... - -------- ------ �; E} JComplefe in Duplicate} .t�- v ` �R ~_ .J-'- -------- - !! Date Issued .--�_Q - I This Permit Expires } Year From Date Issued A lication is her r I pp y 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. JOB ADDRESS AND LOC TIO ------ _ r,A.. � - - - -- --------------------------------------- Owner's Name-- ............------------------- L� . ---------- - ------ -------------------------------- Phone- Address------------------� hone_17 Address------------------;� ntractor's Name_ --- ---- -- ------s .—— Phone-$& Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms _? Number of baths ___L___ Lot size __r�__r___-"�(aQp!"""_"_"_-________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table AV__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeff Hardpan ❑ Previous Application Made: {If yes,date........:...........J No X New Construction: Yes ❑ No X FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.) � Septic ;Tank: Distance from nearest well_________________Distance from foundation------------------.Material __._-------------------------------------------- ❑ �`�"- ® No. of compartments_ - --------- - -------Size------•-------------------------Liquid depth--------------------------Capacity----------------•------ p 11=iel :. Distance fro ea st ell _ Di tanc r m o nd o ____� _ - D" nce to nee est I line_----3____!___ Number of m s t"-- -�---.-- _q --- - ------L n of h �n ------ � � ----- -- i th tre y �i Seepag ad' Type of ter atelia ---------- th of I ter ateria__ -,l _ `.--.--Tot I ___ e�� ------------ e P' . • Distance to nearest well____:----Distance from foundation___.,C�__`__-__".Distance to nearest lot line__.___--_._.__ Number of pits----- -,------------Lining material .__ G-Size: Diameter_--- - -------Dept h---------- `------------- Cesspool: Distance from nearest well-l_--___ _--�Distance from foundation------------------_Lining material_____________________ It ❑ Size: Diameter ,-- Depth ... --------- --------Liquid Capacity- --------------------------gals. ii Privy: Distance from nearest_..well_=_-__-------- ------Distance from nearest building_______---_______________._____ ., � s}.lot line - ---------------------------------t Distance to nearer� � ------- --------------------------- ----- ----- Remodeling and/or repairing (describe):______�_..G r, ""-- i f '. - - = - - __-4. -------------------- ---- -- -- ----- f 11 -- ------------------------------ _ :; :::-------------------------•---------•---------------------------------------------------- ---------- ! here6y certify that I have prepared +h srapplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulati'dns of the`San Joaquin Local Health District. (Signed) oD C �� -- --------------------- -f----- ----------- --------- - --------------------------------------- -- ------ --- Ow or and/or Contractor} By:----------- - Plot Ian, showing size of lot location of s st in re-lafion to wells buildings. etc., can be la f ----- it a)---- -- -------------- - I p 9 � � �Y � g � p %ed an reverse side). _. I FOR DEPARTMENT USE ONLY $ # APPLICATION ACCEPTED BY------- - DATE REVIEWED __ -- =� _T.� -- � f t ---- DATE------------------------------------ BUILDING PEE RMIT 155U1"D ---- ---------------------------------- ----- --------------------------------------- - ----- Ds "A ------------------------------------------------------- TE)..Alterations and/or recommendations.-,.'----- - ---- " � f --- -----•-----•---•-------•---•- -- ---------•---------- `3 l - - ------- -------------------------------------- ---- i t2 < ------ ---------------------------•-.-------------------------- --I- ---------------------------------- t g FINAL INSPECTION BY: f`c_ .c. '. Date----- - `--- rx . ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9.59 3m 3-'63 F.P.CO. �+aws