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FOR OFFICE USE: `--------------- ° °--- �j' _ Permit No. 1/ � _ APPLICATION FOR SANITATION PERMIT -- -- , - - ------------ ----/.r�-'- ._ (Complete in Duplicate) D --------- ---- This Permit Expires 1 Year From Date Issued Date Issued P/ 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. 544. clJOB ADDRESS AND L IAT ON ---------- -�E" t � =' '� 1Ei Owners Name �a 1 ^ -------------------------- - - ------ Phone. 1. Address-------------------------------------- ��) ! ------- ��` ,-- /..._ E Phone-)_�`' e! Contractor's Name--- ------------ ------------------ a ---------- ------------------- Installation will serve: Residence Apartment House ❑ Commercial F] Trailer Court ❑ Motel E] Other E]i �j Number of living units: ----�__ Number of bedrooms --T Number of baths _Z_ - Lot size �1 --Z-0--do-------r----------- I —Z-d-do---------•--------- 1 �� Water Supply: Public system (��/Community system ❑ Private ❑ Depth to Water Table _�_�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San Loam ❑ Clay Loam ❑ Clay ❑ Adobe [A--HSrdpan ❑ Previous Application Made-'!: (If yes,dote--------------------) No * New Construction: Yes E] No FHA/VA: Yes P;--'No ❑ TYPE OF INSTALLATION'1AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) al' from m nts Size Liquid Material p[] No. of compar}nearest wel{_________________Distance from foundatiolq ..d deoh Capacity P ---------------- 5e tic Tank: Distance Disposal Field: Distance from nearest well..... _-._----Distance from foundation_-__,_city----.Distance to nearest lot lire___ �"_._.__ Type filternmaterial_�c C_ Iz__pepthh':of each line_______`+ ._.____�tidth of trench__ --Y__._.._______________ t © �/1 r I------------ Len t ��jj tl f yP i of filter material_1.i�_-______'._.-_T.otal.,�length_p�( __-_- II , Seepa Pit: r Distance to nearest well_ ~--.-.-_Distance om foundation____� --------.Dist ance��to�1'earest lot line_,,,. -_--_-:�.-...r cc,, Size: Diameter—_1._ Ueptn_. - ��,SIO -)Number ofpit : �__ .----Lining material-- - y7 ti Cesspool: Distane� from nearest well_____ ___________Distance from foundation -.._--._ __.Lining material___...._.___ ------ ----------- I% ❑ Size: Diameter-------------------------------------Depth--- ----- ----`------------- -Liquid Capacity ---- --- gals. ` °ll r t Privy: Distance from nearest well------------- -- ------ from nearest building-.-__-------_-__._._---._,_____..-_' [] Distanele to nearest ------- --•- ------ + . IIl F Remodeling and/or repairing (describe): _cQ__� .1_.G_ .,-,e------d,,, ,.. �Q► s IM ----------- �I # ---------------------------------- ------------•----------•------------------------------------------•---------------------------- ----------------------------------------------- IN I hereby certify that hhave prepared this application and that the work will be done in accordance with San Joaquin County )ordinances, State laws, an '- and re_gulatio of the San Joaquin Local Health District. (Signed] I _en - "^ ZZ----------------------------- ------------- (Owner and/or Contractor) 'il B - ----- ------ -- _ -- --- .--------(Title)------ ��-'�� ------ -t Y� , (Plot plan, showing size of lot, location of s to in relation to wells, building , e c., can be placed on reverse side). I� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....... r_ t�-di_..-_.-- - �'V 4` - ------------------- - ------------------------- ----- DATE-------- - - ----- --- --�--------------------- r ----------- - - REVIEWEDBY--------------------(--- -------- ----------- - - ---------------------------------------------- --------------------- DATE------------------------------------------------------------ BUILDING ------------ -- '---- DATE __ Alterations and�r,recomrti -� � �`---�v------ _/7 rte BUILDING PERMIT ISSUED --- ------------------------- -- --- ----- ----- ----- ---------------- ---------------------------------- 4____-- ..-__-_ .-_-_ �� = --------- ---------------------------------------------------------- ------------------- ----------------------------------- I ,0 .,v - FINAL INSPECTION BY:-.-.---- ---------------- -------------------- Date------.�� ----------- � 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