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FOR OFFICE USE: -- .-tea, APPLICATION FOR SANITATION_PERMIT Permit No. ...... Q..... ------ -- ----- -- (Complefe•in Duplicate) This Permit Expires 1 Year From Date Issued 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 o. 549. JOB ADDRESS AND CATIO�1.___ _ ..____V(� ''--------_--- -__--- ._ _. _---_ _eC r__________________________________________._______-___.__.._.._ Owner's Name. -- ---- Phone /v -•-------------- Address Ff �.�/v . Y�� ' Contractor's Name - r ---------------------------------------- Phone��-&-ffr-r. ----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel C] Other ❑ Number of living units: __t---- Number of bedrooms Number of baths J____ Lot size ----- --------------------- ________________________________ Water Supply: Public system 54 Community system E] Private ❑ Depth to Water Table 6-0 ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ Previous Application Made: (If yes,date_.................. ) No �L New Construction: Yes ❑ N01191 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 __.___._--------__...__--____--..---_______-. iC1S-ri VC, No. of compartments------------------- Size-------•----- ------ ----- -----Liquid depth--------- ------ ------- Capacity----- ---------------- .__.._....Disfiance #o nearest lot line- --------------- p _ ��. Length of each line__.:_ ._ 2_____________Width of trench._�. -r_r_ pis asal Field: ------------- Number of iinesearest well . � �Distance from foundation-- _. if � � ---------- 01 - ------ � ' Type of filter material- .. -------Depth of filter material-___/_________.Total length____---_----------___fCt_________-.-- � r Seepage Pit: Distance to nearest w0_. O.II)�___Distance �"_ dation____-._._.Distance to nearest lot line__� _ Number of pits.�J7si.Ccl).__Lining material Size: Diameter-33 t/ Depth .5 Cesspool: Distance from nearest weld ------ __.--Distance from foundation..........-------'•..Lining material_......_-_--___-___---_-.._-___-___--- ❑ Size: Diameter- --------- -. ---:- ---• - ------- D.�e.....t.h...._--________________-_-_____-____ "----_ --�--- Liquid Capacity acitY- --a-- -----------------------gals' lIzz- Privy: Disfance from nearest well/ .... ..........~..._..Distance from nearest building---------.____._____________..__......_ ❑ Distance to nearest lot; Remodeling and/or repairing {descrif--- - - - ---------------------------------------- --- _ a I ' hereby certify tV1h prepared this application and that the work will be done in accordance with San Joaquin Countyordinances, State lawsand regulat, of the San Joa uin Local-Health District. (Signed --- - -------------�- - ----�--------------- ------ : -........ . ---------- ---- ------ -----(Owner and/or Contractor) Plot tan, showing size of lot, location of s stein refa ion to ells buildings, etc. can biele lac d o By: ( )----- ... . ...---._...------ ( p 9 � y g , p n reverse side). tf R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- = f ------�------------------------------------ REVIEWEDBY.----------- --------- - ------ ---- -�-------------------------------------- --- ------------------------- DATE-------- BUILDINGPERMIT ISSUED-------- -- ------------------------------------------------------------------------ ---- ----------- DATE-----------`---------- ------------ ------------------------- Alterations d/or reco rtdatiarisf -- - -- -- ----------------------------------------------------- • ---------------------------•-------------------- ' ---------------------------------------------------------r. .----------------------------------- ........... �_�-------------------- 1----._. ---------,---------------- 'fYY� ------- ------------------------------------ --.....--- -- _..- --------- ------------------------------ ♦ :rtw � s1, �G f C 7 FINAL INSPECTION BY:- I�'-�-- _ .'..-.�- --- - ------------ ----------------- Date__.......----1 -- ----�'.�_....- ---------------------- ----------- - 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 E.H.9 2M 1-67 Vanguard Press