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FOR OFFICE USE �a� 6 ----------------� (� g " �.-3 --- APPLICATION FOR SANITATION PERMIT Permit No. - - - (Complete in Duplicate) ']/�L_/_.r 6b ----------------- - ---- This Permit Expires 1 Year From Date Issued Date Issued .__7._ 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. JOB ADDRESS AND LOCATION--------`544 f � ----4/"� --------------------------------------------------------------------------------------------•------- Owner's Name--------�__,___ci..--�_ -. aee_...------•-------------------------------------------------------------------- Address-------------------�11' -7--l..i ,----0, V-----••------------------ -------------------------/----------•-------------------------------------•--------- --------------------------- Contractor's Name------ Phone �dB r'� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ___ Num, er of bedrooms -.7-- Number of baths ---I--- Lot size __________.____-._-_-----_________________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of "feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous App ication Made: (If yes,date -_--..--_..,_____-) No El New Construction: Yes E] No ❑ FHA/VA: Yes E] No ❑ TYPE OF I YALLATION AND SPECIFICATIONS: (No sep ' k or cesspool pertifiitted if public sewer is available within 200 feet.) Se is Ta f 'stance from near st well_____ _.___Distance from foundation----- ____._.Material -----_-----___----.--------.-----_---------- of compartmer4s-------------------- - --Size----------------------- -----�quiddeF'.t-------------------------Capacity-- Disposal Field: Distance fro, nearest well-----------------Distance from foundation----- -------.Distancesto nearest lot line-A-20-2 __- (� I Number of Ii. _f Length of each line--------- �. _ __.Width of trench----- _._'!� I Type of filtel material_ .__Depth bf filter material =r/ -/ T ta3�e`gth__-_______�[-_--_--___-_-_-__- 01 Seepage Pit Distance to nearest well-_---_—r-------Distance fr fo ndetion-----�Q- 'tan/to nearest lot line__w---- Number of pits y-----------Lining mate�i.al r Depth------- f Cesspool: Distance from nearest welh.___w __.____.Distan� from foundation-------- ---- __-.Liri-n� material,_ _`________________________..__. ❑ Size: Diamet'r_.f ----------- ------ "---De th--1------ - Liquid Cap�Scity;------- : -------gals. } ..r Privy: Distance from nearest well______. c_------ __(_�--- .-__-_;`Distance from nearest 6uildm ❑ Distance to nearestllot line - _ - il Re delin and/or epairing (d s' il,eJ: } /�r � �� /--GlCat�fl� - -•- _--___- !1f1- -- -- ----- 1 f - `-- ��------- �---- 'rte ------------------------------------------ - r -, I hereby certify that I haveprepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �j � ( ` [I� �.�/ (Owner and/or Contractor) {Signed} �/ ��' �-- - --- -- � e------------------------------------- -- -- ----------------------------------(Tifle)--------�r ,r--------------- - ---- ------ (Plot plan, showing size of lot, lo' ion of sys+em in relation to welts, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- DATE------ 1 --------------- --------------------------------- REVIEWEDBY- -- - ---------------------- - ------------------ ------- -------------------------------------- DATE-------------------------------------- BUILDINGPERMIT ISSUED----------------------------- --------- --------------------------------I-------------------------- VATE--------- ------------------------------------ ------- Alterations an for recommendations:--------7._1-T 11_ ----(c, G-_-. t -_l f ^ .......... ✓ - ------------------------- ---------- --------m _ - ------ -- --- ----------------------------:-- � - • ----- Y�-�-- --�-----•----------------- ------------ ` --t-L --------------------------------- ------ --- --- -------------------------------- -------------------------------------------- •--------------------------------------------------------------------------------------- FINAL INSPECTION BY:. � --------------------------- Date----------------------------� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California