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FOR FFlCE USE: ------------ ----------- ------------ --------- --- ------------------------------- - t� _ """--_.-"-_-". APPLICATION FOR SANITATION PERMIT Per No, .....................� ------------------------------------------------------- (Complete in Duplicate) -- --'---------- ---------- ---- Date Issued ---- This Permit Ex ires 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. y This application is made in compliance with County Ordinance No. 549. J08 ADDRESS ANb LOCATION_ r " 4-47 716 WZI-PZ 4 '10 � - ---------- Owner i m �.rrfr Phone" .__-" Address---------� ----"-- • Contractor's Name----_-_-- - "AP- --------------------- -------------------- Phone..--. Installation will serve: Residence ®""°Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms _-/-- Number of baths Lot size Water Supply: Public system ❑ Community system ❑ Private [��Depth to Water Tabie AP ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ date.___--__,_----..-_-) No � New Construction: Yes E] No ®"FHA/VA: Yes E] Nom• Previous Application Made: (If yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SX16;fXf T,a - — ��— - ,� Distance from nearest well---------------_Distance from foundation--_-----_-----__.Material ---------- No. of compartments----------- ------------Size--------------------------------Liquid depth------- ------ ----------Capacity-•--------------------- Disposal Field: Distance from nearest well ��--pistance from foundation___ AP_-"--."_Distance to nearest lot line_ ____ Number of lines --- -- +_ de -_-�- Length of each line__A90__----��--- Width of'trench. '" ---------------------- - 1 Type�f-filtei°material"; �v---Depth of filter material--__"_ ----_Total len th-__ g =----------=------------ Seepage Pit: Distance to nearest well I_^i._--__- _ ��. �__..""_Distance from foundation--------------------Distance to nearest lot line-------_-"--_--+ ❑ Number of pips'_.f._=_--- ___Lining material----------------------- Diameter_----_-"-_._ t f,` K..,, ,- Depth--------- ------------ ---------- Cesspool. Distance from nearest well__--___ :.""Distance from foundation ------------------- Lining materref ___ ❑ Size: Diameter-""-= -- ----- --- --IR------._Depth- _-- �' r Liquid Capacity. 5 f -----------gals. Privy: Distance from nearest weH" -_--------- ----.g-"--".)„ ' Distance from nearest building ---------------------------------------Distance to nearest lot line------ -------------------------------------------- -- Remodeling and/or repairing (describe,):.- --_-- _ ; w` A s a � /'�� ------------=-;-------------------------------------------------------------------- --------------- ` r ------------------------------------ ._ ---------- ---------- ------------------- --------------------------------------------- =---------- ---- •---------- --------------------------------------------- I } P ---I I ---------------•--------------- a --- ------°------------------------------------------------------------- hereby certify`that l have re ared this application and that the work vVill�"b`e�'done in--'accordance with San Joaquin County ordinances, State laws, and rules and'regulations of the San Joaquin Local Health District. ----------- (Signed) A ZZ_ _ --- ----- ------ p a --- ---------------------------------------�/or Contractor) 9� 8Y -------- -------------------- ----------------,; f ---------)Tale)--- ' /i� -- - -------- ---------------- Plot lan, showin size of lot location of sy min relation to wells,buildin s, etc., can be laced on reverse side). I P g ;—FOR"DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY . ®. t -------------- DATE------ ¢ 1 REVIEWED BY------------- - "` r M s }. _ ` ------------- ----- DATE BUILDING PERMIT ISSUED------------- --------- ------------ -- t!� -------------r----------------- - ---------------- DATE - t r` --------- Alterations and/or recommendations:--_"--._"_ _-- _. ------------------------------------ - -' # 4 ----- 1 ------------------ -- --- :------------------ ---------- ------- . --------------- --------------- - --- - ... t. } {f ' . FINAL INSPECT]O Y_ Date--------------- = SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ava. 300 West Oak Street '' ' "°r " 724 Sycamoe,Stree0 205 West 9Th Street Stockton,Califofnia Lodi,California Manteca,California Tracy,California F.P.0 O. " t