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FOR OFFICE �p f - APPLICATION FOR SANITATION PERMIT Permit No. � �.. omplete in Duplicate] / Xd.,.. Date Issued .__.___""__....__-------___--- - ___.. _ This Permit Expires 1Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thework herein descrb This application is made in compliance with County t+dlhaance No. 549. ----------------------------------- JOB ADDRESS ANDS OCATION__ t = --- Al 1 � = <.•.. r ----- --------- --- ------------------------------ SS Owner's Name # A - -------- on ._ Address------------------------- - a J---------- . ----•• •----------------------- = - •- --- Contractor's Name--- -----------_--_01'i �'tri-----•------------------V.- ` Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Tra•er Court ; Motel Other ❑ Number of living units: ---- mbar of bedrooms`Number of baths _� .Lot size °�_J-- ---- --- Water Supply: Public system Community system"[] Private ❑ Depth to \Nie r Table -------- ft. ( _ Character of soil to a depth of 3 feet: Sand [-] Grav{ ❑I, Sandy Loam F1 Clay-,Loam ❑Clay ❑ Add be 8--lHardpan C] Previous Application Made: {If yes,'da#e-----------_-------l No 91""New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS. 1- ;. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) • x rt �epfiic k: Distance from nearest well__/13Ce:Disfance from.fou�ation_ �________MateraaL__ ___ � .. No. of compartments Size_. LIG epth r Capacity Disposal Field: Distance from nearest w IL. _ -Di -- P --� stance from foundatio� _�-�---___.Distance to nearest lot lin ___�. _. �, Number of lines___________________ ____ Length of each line ' Width of trench_._.___ _.._ �_;.. /� Type of filter rriaterirl �_WA .. _ Depth of filter material----/ _ Total length___.__I�__ __Seepag it:- "Distance to nearest w ��____Dista fro found ' ' n___.�_______,._..Dist�cp�fa nearest lot lin ____... ze. Diameter------- _ -----Depth------- -- ------ . � p .. �------Lining mated --- � - ------ - Number of its: ___.__ __ � _ . `�-- ,j Cesspool: _.Distance from`nearest well____________''_'Distance ation--------------------Lining material__._._----- - ___ _ ___ ❑ Size: Diameter -------------- -- Depth-------------- ---- --------------------------------Liquid Capacity gals. Privy: Distance,from,neare � ,_ st.well---_--.____ - _ -. -_-____ -__ -Distance from nearest building_________________ -------------- ❑. Distance to nearest lot line----------------------------- ----------------------- ------- ---- -- ------ -- ------- - d�Iraq and/o.�repair.ing [desc�iUe): ------------- A. �sr F ----- ]i --+. ,'Lr i. la h-.y�: --- - ------- r-I ----------- -- --- --r------ ---`-- ---------- ------------ ------------------------ -•-----r-------- ■3-----• TF # --- ---- ---- ------------- --------------- 1 --- == ----- r 4- -- t +�, nt I hereby certify that I have prepare this aVpplicatii and that the work will be done in accordance with San Joaquin County ordina�ices,�State'I s, nd rules and re lationan Joaquin Local Health District. iF � VIA T __.___..___ (Owner a Contra (Signed} 7 -- . ....... ----- - [Ow and/ tor} By:---------------•-•----------.------------.....-s------------------------------------------- ------------------------------------(Title)------------------------ (Plot plan, showing size of.lot„location of system in relation to wells, buildings, etc.,.can be:placed-on reverse side):- ' FOR DEPARTMENT,USE ONLY i APPLICATION ACCEPTED BY-- - --------- ---------------------------------------- DATE-------9? --/003;� �--------------------- REVIEWEDBY-------------------------------------------------------------- --- ----------------------------- ---------------------- ----- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE.. --------------------------------- r Alterations and/or recommendation --- ---- ---------- ---- ----------------- -- „2,/—__G ----- --- ----- ------ -�� -- ------- ---------- '--- __c . _ _.� ' ----------- ------ ... ----------- - FINAL INSPECTION BY:..---- = Lia------------------ ---------- Date---- - -- ---------------------------------- ,t , SAN JOAQUIN*.,LOCAL�,HEALfH DISTRICT 16 V\ 1601'E.Ma:elton Ave. 300 West Oak Street X124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California �� Manteca,California Tracy,California E5 9 REVISED S-S9 3M 3-'63 F.R.CO. �'