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Distance from undation. _ -Distance to nearest lot line
<br />Depth..
<br />Distance to nearest_well
<br />Ntirnber of pits 2. Size- Diameter 33 Lining materialf.
<br />4 \r.
<br />APPLICATION FOR SANITATION PERMIT
<br />(Complete in Duplicate)
<br />This Permit Expires 1 Year From Date Issued
<br />FOR OFFICE USE:
<br />Permit No. .
<br />Date Issued 7
<br />. pplicattion is hereby ;nade to the San Joaquin Local Health District for a permit to con-ruct and install th.e. work herein described.
<br />This application is made in compliance with County Ordinance No. 549. 7.-h•Dr-J, no 7 - us° - 26
<br />r. •,12...3. ('',/ Cr---C • .1-4...57 ,',:i. 4-4 • .: A . ,2,,c ...
<br />,,t-dt4-..4 .2 111 / I 61/244,1 JOB ADDRESS AND/L CATION 1/46g*Zieses 11,40/ - 6"-k11.4"34.- ' 1/3 27
<br />i Owner's Name.....,/9 .d... 4, . # )27 ,41.,„r... , /
<br />Address... . 6re".• P,- it? "./ ‘,..,2- / ) I
<br />Contractor's Name ?,••17 .rtlett•-en,•",e.-.......----..,... —
<br />Installation will serve: Residence El Apartment House 0 Commercial 0 Trailer Court 0 Motel 0 Other 0
<br />Number of l':ving units: Nunlber of bedrooms 3 Number of baths Lot size 9/ 11"
<br />Water Supply: Public system a, ComMunity system Private E Depth to Water Table '
<br />Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam 'Clay Loam 0 Clay PO Adobe 0 Hardpan
<br />Previous Application Made: Of yes, dote_ .) No I-0 New Construction: Yes all No FHA/VA: Yes 0 No 0
<br />TYPE OF INSTALLATION AND SPECIFICATIONS:
<br />(No septic tank` or cesspool permitted if public sewer is available within 200 feet.)
<br />Distance from nearest weil....227.....Distance from foundation Material e-ei;'"Le'lt,
<br />No. of cOmPartments Size1/14-4 9P-r ' ....
<br />Diitance from nearest well .j 0 Distance from foundation i° • Distance to nearest lot line S".'
<br />Njmber Of lines' 2-.............Length of each line tiro ;.„ Width of trench
<br />Tyine of,Nter material YkaPti. Depth of filter material I7 Tot& length 1.-0-1'
<br />Cesspool:
<br />0
<br />rivyt
<br />0
<br />is
<br />Distance. fi'om nearest well Distance from foundation Lining materiel i
<br />Size- Diameter • ' Depth _ Liquid Capacity gals
<br />' r ' ... ir 4
<br />
<br />.. , _, Dis.tonce -from nearest well , Distance from n .. earest building........... ..... _.----............. .
<br />. Distance to nearest lot line .„..- .-_, : - • . — „is.— . -..- , . , .
<br />Remodeling and/or repairing (describe):.
<br />
<br />444
<br />
<br />I hereby certify that I have prepared this application and that the work will be done•in accordance with San Joaquin County
<br />ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.
<br />(Signed) -
<br />4 . ._ (Owner and/or Contractor)
<br />By (Title)
<br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).
<br />Phone
<br /> Phone
<br />Septic Tank:
<br />Disposal Field:
<br />Seepage Pit:
<br />/`•"
<br />UN1
<br />Cs'.)
<br />FOR DEPARTMENT USE ONLY ,d1
<br />APPLICATION ACCEPTED BY.. . DATE.. 4°T
<br />REVIEWED BY DATE.
<br />BUILDING PERMIT ISSUED
<br />Alterations and/or recommendations:
<br />4.44, 44 • 44,1•441,11••••••••••• 40••••••••••••• • U. • ••••• • 4.4 •••••• • • 4,4411•11....0.4.0 WOW. •••• • • .... 4..44.44 • •••• 4•4 • •
<br /> 4,04••••••••••••• 40 • • • ••• ....... 4 4 444 10,0 .44 4.4 41v,, ... on 41••••• N•41
<br />.... 41444•••••••••••••••••
<br />
<br />. • .0. ••••••• 44 • 4.1•44, • •4444410,4114. 41, 4,4 . +.•• •44 • 4*
<br />Aro
<br />FINAL INSPECTION BY•
<br />SAN JOAQUIN LOCAL HEALTH DISTRICT
<br />1601 E. Hosolton Avo, 300 Woo Oak Street
<br />124 Sycamore Street
<br />205 West 9rli Street
<br />Stockton, California
<br /> Lodi, California
<br />Manteca, California
<br />Tracy, California
<br />forvinED
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