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FOR OFFICE USE: <br /> .......... �.....................-----_----._... <br /> ." .... ............ , APPLICATION .FOR SANITATION PERMIT Permit No. ,,;?�._7 . <br /> -----•--- .........-.................. (Complete-in Duplicate) �.r.... .=4 <br /> -----_ This Permit Expires 1 Year From Date Issued Date Issued 10. -�.l <br /> -._ -2 t�-- SFO--f O <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein crl ed. <br /> This applicotionjs,.made-in..compliance with County Ordinance No. 549. <br /> 3:o.�..—� _ .: <br /> JOB ADDRESS AND LOCATION. .A_ >.. --•--- ...... G�....... -'--- <br /> Owner's Name...--- . <br /> .--_.... Phone.81,23.- <br /> Z . 4kAs <br /> Address...............••-. S? .............. .-•---- .. ...............---.......................--•-•--•---•.........._.. <br /> Contractor's Name.................. -- ........... .................... Phone O �Pl <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court t Motel ❑ Other ❑ <br /> Number of living units: .-(.... Number of bedrooms Number of baths An. Lot size n_6t� . �._�................. <br /> Water Supply: Public system ❑ '.Community system ❑ Private j% Depth tc,;Water Tablelt.- ft <br /> Character of soil to a depth of 3 feet- Sand $1 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date.......___. ....... ) No New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ No)� <br /> STYPE-OF INSTALLATION--AND'SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.................Distance from foundation...................Material ......_.................--------------......... <br /> ❑4fj(jSTZ' No. of compartments..........................Size..................-............Liquid depth-.......- .... Capacity........................ <br /> Disposal Field: Distance from nearest well./0i9r-._.Distance from foundation..:=? ........ Distance to nearest lot line.l1r1.- ..... <br /> R. Number of lines._.its _. 'i Length of each line......:s'2....�......_.Width of trench.... ................... . <br /> Type of filter material. C '..t:.Depth of filter material. length.____ �Q.......................+ 1 <br /> Seepage Pit: Distance to nearest well................_.....Distance from foundation........._..........Distance to nearest lot line................. Q <br /> ❑ Number of pits....................Lining material......................Size: Diameter----------•............Depth................................. + W <br /> Cesspool: Distance from nearest well................Distance from foundation...................Lining material...................................... <br /> 11 Size: Diameter... _........................""'Depth......................._..............._............Liquid Capacity............................gals. '. j- <br /> Privy: Distance from nearest well................................................_Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line........... .........•----------.-.-.-......- •-" ,- <br /> Remodeling and/or repairing (describe):_.._._. ._...�_-. _... .- -•-.-•- .��'....................................... <br /> _. <br /> ........................................................................-...................._......................................................---------------------------------------------------------•-------- <br /> ,-i I hereby certify that'l h prepared this application and tha +he work will 6e done in accordance with San Joaquin Counfy <br /> ordinances, State laws,and s and regulat' s of the San Jo uin Local Health District. <br /> (Signed)..................:......... ....... ..... ....... ..............................................._.........._._.(Owner and/or Contractor). <br /> (Plot land showing ( , location of s t in relation to wells,�-----.•.-".-..••••�-.........(Ti _ .- '.._......... <br /> ._._.............. <br /> eyi <br /> ( p g ys ells, buildings, etc., can be place n reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_------ R AR ----------------------------------..............------_--------- DATEAJ-0- - z6.. .........-- .............. <br /> NREVIEWEDBY...-----"------------------------' -"-.....--"---...-----........•..._.....-----------------------• ................... DATE.................................................. <br /> BUILDING PERMIT ISSUED..............................................................-...................................... DATE..............------._....----•----_---_-"--•-•----•-•-- <br /> Alterations and/or recommendations:............................................................................................................................................................... <br /> Y <br /> ...........................___......----•-..............................._....--.....................__..._......----._.......____•____.-._.._.__....._......_.....__....................................------------...... <br /> FINAL INSPECT N B Date..............r-_'26.: � ................................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselten Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,CoNfwalo Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />