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t OFFICE USE =s� . _7 ------ --------f 3 ------------------ ------------------ APPLICATION FOR SANITATION PERMIT P;emit No. ___��f�_____ ---------------------------------- ----- ------------- (Complete 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 No. 549. JOB ADDRESS AND LOCATION__ a_.4_1_..aa,__,�t -. .__.?,I ------------------------------------------------------------------------------------ l Owner's Name fib`'& -�d�4 - �- z,r Phone------------------------------------- Address --------------------- - - -- Contractor s Name -------- ----- Phone_:_��. _.. ._Yz_7 tr i Installation will serve: Residence t2 Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ E Number of living units: __1-.- Number of bedrooms __�_ Number of baths ---/--- Lot size ____.___.--°73:7X /"d Water Supply: Public system �ommunify system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: ,Sana-o rG'ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3--Harcli ❑ Previous Application Made: (If yes,date_ ,_`:.._.. -_,_.) No ®— New Construction: Yes ❑ No FHA/VA: Yes ❑ No ?4—.-1 r TYPE OF INSTALLATION-AND SPECIFICATIONS:;,,"'- (No septic tanks or cesspool.permitted if,public sewer is available within 200 feet.) Septic Tank: Distance from. nearest w5ell.'.__'�":-'.`bistance from foundation-------------------.Material--------------_---------------------- ____ __No. of compartments:___ 1 Size--------- Liquid depth- __..Ca Disposal Field: Distance from nearest well--X/P-,.._Distance from feur ion-._- r Distance to nearest lot lie -------- � T e of filter material- �ti_6�-f�-._.De gth of filter material____._/_� - ^y___:W'dth of'trench_-___Total length_____._-_310 ._�:_ --------------- _ _ Number of lines------ ------:-----.---------Len th of"each fine-- _J9--------------,4 yP p d---_ =_._ ._ 1" - ------------ Seepage Pit: Distance to neatest well....,ll�6_____...___D.istance from foundation----- to nearest lot line _f __--__-_.� Number of pits-_'_.._._�_ L'ining material,.__ _4_c_ .-Sizes Diameter---.3-.3-_---r------_-Depth-___-Z '��----------------- Cesspool: ---------------- Cess ool: Distance from neares�w:ll t. _Distance' from foundation -__ _.Linin material__.--- .--- _�_______-- _____1� P h g Size: Diameter--`____ De fh-------------------------- _____..Liquid Capacity_ ----------gals. Privy: Disfance from nearest,well________________________________---__-,-A -_--,Distance from nearest building------------. ----_---_-_____ Distance o ne t line---------------------------------- _ _` Remodeling and/or repairing (describe) ____-__.._-___________________-___________ ----------- -- : 31 ----- ---- ---------••-•-------------•---•------------------------- -------------------------------------------------------------------------------------------- ----------------------- ------- v y }y * -------=A-`--------------------------- ---------""-------- --- w 1 _:I ` ordinances,bState lavish and rules atidare u ations of the San Joaau nlie-wo k will be - -- in --cc - .-- ui t i done in accordance with San Joaquin County g q District. f------------------------------------ , (Signed) - �-------- ------- --�_-- __-- ----- -- i----_--`---- -------(Owner and/or Contractor] I �% - ------------------------------------------- ---------- Title --------------------------- ------------..-..-.:-._---------- By------------- ,.., (Title) (Plot plan, showing siz of lot, location of system in relation to wells, buildings etc.; can be placed on reverse side). t tt fi ti FOR.DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------ `.. - r DATE - == 1 6 REVIEWEDBY g--------------------- }------ ---- -------------- ---------- --- -------------- ------------------------- DATE - BUILDING PERMIT ISSUED = t ----------- -------------- ------ DATE------------------------------ ------------ Alterations and/or rec'mmenrdatians:---f----------=--------- -------"-- --------------------------•--•---------------------•----•------•----•-------------------------------------------- - = . --------------------------------------------=------------------------------------------------------------------------------ ------------------------------------ -------------�-- ----------- --- r t ---- --- -- ------ ----------------------------- ----------- ------------------------------- ------------- - - - - ------------- r :{ �--------------------------- -- --� _ Date J '' .? .lz.S - ----------------- -------- I FINAL INSPECTION BY: _-..---? SAN JOAQYUIN LOCAL HEALTH DISTRICT 1601 E Hazelton A,.\. why 300 West Oak Street 124 Sycamore Street 2D5 West 9Th street l Stockton;California Lodi,California Manteca,California Tracy,California "f F.P.Cp.