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FOR OFFICE USE: . � - ------ ------------- ------------- ---------- - `` 7 .�-- .� __________________3_f,�j . APPLICATION FOR SANITATION PERMIT Permit No. _.. .... ___________ -------------------- - r `� [Complete in Duplicate) / _.- -•-�-�--�rr �._w. --�- _� _ - - ._Date-Jssued...�_ . This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District—f a-RRe to construct_an_d install the work herein desc ibed. This appEicaWn is. made in compliance with County Ordinance No. 549. a� �� T}4Tf`�.�Son� J � JOB ADDRESS AND �OCAT]ION.._ 0-� S __ ____ �� . a99.--"I--- --5 --- �,I_N.y- - p -- -y, - ---1-c� ,�o,u---- --* Owner's Name [� 1 ----•---------------------------------------------------------------3 : _ __... Phone Address-------------------------!•• ._....... 7 -4.i..- �'`. Y �._...... - - Contractor's Name------t------------� ,L?.. }---- _-- {tt3 � J--------- _ ---------------------•----- --...-----•-- Phone..------•----�----------� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Crurt ❑Y Motel ❑ Othe'❑ Number of living units: __..___ Number of bedrooms --- Number of baths .___ Lof size Water Supply: Public system ❑ Community system ❑ Private epth to Water Table6'- ft. # t 1 ~ !- }-_ -r --- 'r-- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ° SandarLoam ❑ Clay Lom ❑ s;Cl ❑'" Adobe a- Previous Application' Made: (If yes,date____________________) No New Construction Yes o ❑ FHA/VA Ye I o TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 fee Septic nk: Diftance from nearest well_.5V-------_Distance from foundation_,!.__ Material__ �.-''r-C -.!_�_-�-__. N. of compartments-----�---------:_f--Size-- _=.-_X� quid d'pt,__--!� ---------------Capacity..l -O-.-_— Disposal reld: Distance from nearest well.-.. _-_-_-___Distance from foundation__/_A-------------Distance to nearest lot Iirie.j_ _�_ -- Number of lines---.------ ____ ______________Length of each line------ _ a%Width of Type of filter material.___ acs__ � 1 � �__-____ t� yp �_ -zr,��C}epth of filter material______ _____ ______Total length----- Seepag it: .Distance to nearest well----- Distance from foundation___)_4..... to nearest lot line__1_.T�___.__ �d Cl f A Number of pits--!---2 ------ -- 9 - - - _ Linin material__7f'�.__�_Size: - Cesspool: Distance from nearest well_________________Distance from foundation---_--------------_Lini.g material `___ _`___ _ _..___.___. ❑ � Size: Diameter-- ----------------------------------Depth----------------- ------------ '-----------------Liqu d Capacity-.--' ---------- --------gals.N Privy: Distance from nearest well---------------------------------- from nearest"building.___.__________.____________-_t__ ❑ Distance to nearest lot line ---=---------------------------------- Remodelin and or repairing describe :_____._-`..__ _._ --_— --------_-_: . _____________ g ;/ p g i '. 1 --�Jd- - ----- �- 1.:1.:x...------------Y- -• ---=-----I,.,�:_. __�----- -- % ------------------------------------------------------------- I... -� --------------------------- -------- f j I t ---------------------------------------------------------------------------------- f i ordinances State I s; d ules uIa ---------------------------------------------------------------------------- - --------------------------------------------------------- I hereby certify that I have prepared this application and'+hat the work will be done in accordance with San Joaquin County ns of the+San Joaquin Local Health Distric+. {f (Signed) -- ------- ------------------------------------------------------ ----(Owner and/o Contractor) I l r+le r 1 W ---- - --- ------- F �---- By- --- ------ - [. )-- -- ---._...._. .... ------ v, (Plot plan, showing sizi. of ot, cation of system in relation_ o we k2buildings, a+c.,..cari,be_placed=on.reverse._side).. � "` - ' FOR DEPARTMENT USE ONLY ` aAPPLICATION ACCEPTED.BY-------- - ------------- .�'` -------------•-------------------- DATE----- - REVIEWEDBY---------------------------------------------- --------- -------, -------- ---------- -:-----------------------------:- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------•--------- ------------ _ ------------- DATE------------------------------------------------ Alfer tions and or recommendations: - -------- ---------- - - - 4 ------------ ---G� A -r - ---- -- c.�u- : xy 1= �= �'-�- ---------- --------------------- -- - -------------- � - 7 _ '�-` ---�'-----------�t Eft-----•----------------- ------------------------------------- ----------------------------------i---------------------- I... a =----------------------------------------------------------------------------------------------------------- ------------------ ------------------------------ -------....... FINAL INSPECTION BY:..../ . Date ` 1 �: ------------ SAN JOAQUIN LOCAL HEALTHDICT f, 1601 E.lfa:eltan Ave. 300 West Oak Street ! 124 5 ca ore Street J 4 L '` Y { C 205 West 4th Street Stockton,California Lodi,California Mariteca,-California Tracy,California to f y ES 9 REVISED S-S9 3M 3-'63 F.P.c O. �� _� \� .4 1� � �•r