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FOR OFFICE USE: / ------------------------------- L APPLICATION FOR SANITATION PERMIT Permit No. ../..7,. .t�.._._.. (Complete in Duplicate) - .Date Issued _________________ _____________________ ___ This Permit Expires 1 Year From Date Issued 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. T7'� 7o VP— JOB ADDRESS AN CATION /i/_ Owner's Name------ ------ Phone------------------------- Address-- ------------------- � '-°-----1---- -0.-)(-------- 1 Cri__�h/1,� '... Contractor's 'Name =------------------------------------------- --------------. Phone........ -•--------- Installation will serve: Residence Apartment House ❑ Commercial- ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____ Number of bedrooms,---_ Number of baths __Z 1CA� -- Lot size ________ 1__. _ .._____-_ Water Supply: Public system E] . Community system ❑ Private Depth toWater Table ft. Character of soil to a depth of 3 feet: Sand ED Gravel ❑ Sandy Loam � :CIay,Loam ❑ Clay ❑ Adobe ❑ Hardpan [3 Previous Application Made: {1f yes,date-----------7 ---- } ,No Er *`New Construction: Yes E] No ❑IFHA/VA: Yes ❑ No [. TYPE OF INSTALLATION AND SPECIFICATIONS; (No septic tank or cesspool permitted if public°sewer is available within 200 feet.) F S tic Tan : Distance from nearest well------ _{Distance from foundation--------------------Materiai_.__-_-._____.________.___-_._-.______.___. of compartments--------- I ------- _ 'Size__________ Liquid depth----- _ _ ____--Capacity Disposal Id _ : Distance from nearest ell671 Distance from foundation_ -V_'------Distance to nearest lot line-_ Jj ne • Number of lines_______ __ . ; gth of each ___ _ __: ep _ th.of filter mater.ial ____,/I__"J____Total. length____./_0V___j__________________'J��, fYPeoffiltermateria___ �*J - fo ___________________Distance to nearest lot line____-_-..--____- See❑pa a-;Nit Distance oneareswe ----_-- ----,Distance from olundatin Number of pits----------------------Lining- �atenal__----------__-- !:__.Size: Diameter-----------------------Depth-------------------------------- CesspoolDa nearest wet!___--_____:------Dshfrom foiundaton--------------------Lining material--------------------------------_--_- ❑ zeDamter_ ------ Dept - -- Liquid Capacity----------------------------gals. Privy: Distance-from nearest well-----------r_____ ___________________--------- __Distance from nearest building 3 ❑ Distance to nearest lot line--------- -----------------------/I----------- '° ---------------------------------------------------- r ' } r: A Remodeling and/or repairing (describe)'`---- -------- =-- -- ,d!> :' . ---- •. ------------------ t, --------------- C� ---------------- t - --------- - { .�, -1 _ � - __ i :-- ------- ---- t l -' l hereby certify that I kav6 prepared this application and that the Work will be done in accordance with San Joaquin County ordinances, State laws, ides an;isysfem on of San Joaquin Local Health,District. i I (Signed ] �.. Owner and/or Contractor ----- ------ ------ ( / ) t --------------- !�- �'�-------- Title (Plot lan;shbwin size of-lot,-locatioIn.relat - - { ] - .--- - p gton to wells, but ings, etc, can be plat on reverse side). FOR DEPARTMENT USE�-ONLY- APPLICATION ACCEPTED BY----- -•------------- -------------------------------------------------- DATE------- "�--J�----------------------- REVIEWEDBY ------------------------------ 1 - -------=------- ------------- DATE---------- BUILDINGPERMIT ISSUED------------------------------------------------4 -------- ------------------------ DA•TE------------------------------------------------------------ Alterations and/or recommendations: ---------------------------------------------------- ----------=------- -•------------------------------------------------- I i s ------------------------------------------------------------------------------------------------------------------------- '----------------------------------------- --•----- -------•------------------------ is 6. #. -------- ---------•------------------ -- --------- ------------------------------------• --------------- = ------------------ ---...----------------------------------- = ------I---------------------------------------- -----------------------------------------"----•-----"-- ----------------------------- ------- --------•--------------- -------------------- ---------•--------•----- ----------------- ... ------ ---------- ----------------------- -- ---- --- ----------------- FINAL INSPECTION BY: � ��.4 ' Date- /�' .__ . ,�` -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Avg. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r"; Stockton,California lad!,California ` Manteca,California Tracy, California ES 9 REVISED 8-59 3M 3-'r3 F.p.p D.