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FOR OFFICE USE: --. I__._------- APPLICATION FOR SANITATION PERMIT Permit No. . .�.. .� - -- ------------- ---.-_ -------- ---------- - (Cornplefe'in Duplicate) bate issued� 7 ! - - ___/��_ __� v ----------------------------------_........I-.#------ This Permit-Expires_1Year From Date Issued 3 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. 549. : 2--.4 JOB ADDRESS AND OCN .__ $ .Sc � 1 � ''�- "`t'�'--•Owner's Name-__- .. ...- ---------7-------------------------- ------------------------ ----------- - -- Phone----------------------•------------- - -------- - 4 Address.-•---- 1 `J Z7- ---------- ------------------------------------------------------------------ ne Name___________ 1 ------ =�` Zke. - ' -----*------------------ Phone Installation will serve: Residence Apartment House❑' Commercial"❑'�"Tsai€er Court"❑ `-Motel-E]-`Other ❑ Number of living:units: __---- Number of bedrooms -3_ Number baths _ Lot size ----..70-----X- o•�___......#..___-____._ t 'Water Supply: Public system ❑ Community system•❑-�P�ivate Depth t Water Table _.�. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑"r Adobe❑ Hardpan ❑ w.. Previous Application-Wade-.' (If yes,dge............---------) 'No ❑ New Construction: Yes ❑ No []-'t FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLAT ON;ND SPECIFICATIONS- t (No septic taek or cesspool permitted if public sewer is available within 200 feet.) .Y. Septic Tank.., � Distance from,:nearest well_________________Distance from foundation--------------------Material---.-------------------_-------------------------- ❑_? l N,o.:of;com pa rtmencs---------- Size._.__... Liquid depth Capacity Dis.p al:Field: Distan e'from nearest well__________________Distance from foundation___.______-_---.__.Distance to nearest lot line--------.------- Number of lines----------------------------------Length of each line------------------------------Width of trencl�------------------------------------ r Type of filter material_________________________Depth of filter material-----------------------Total length------_-------------..-------------------- Seepa it: Distance to nearest well:___hP®_________Distance from foundation___.__Q'.......Distance to nearest lot line------i�___- e Number of its -� ----- Lining material----- --------- p �+Q---•---------------- Cesspool: -------- C ' " t -_Size: Diameter._. . �� De th... l Cesspool: k Distance.from nearest well t _Distance from foundation--------------------Lining material ----..-_..__.____.______:__________. � Size: Diameter= `�-"';De Depth------------ __._-._________Li Liquid Capacity'❑ ----- p _: 9 P Y gals. V _Distance from nearest building Privy: _o- .. Distance,fromrriearest well---------------------------------------------- 9 ------------------------------------- Distance -- - -------- Distance to nearest lot line -- T _ -------------- Remodeling and/or repairing.' ribe ------- -----------• ----- ----------- --------------------------------------------------------- ----------------------------- ___________________________-__..__._-_.__________ --_;_}______-______---.___.___4---------------------------------------------------------._-.-________--___._____.__-_--.-. . I -- t _ - ___________________________ _____ ___ '______ -________,_ _____--.__--____--_.____________--_-________.----------------------------------------------------------------------------------------._--.__-__...__.---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regulations of the San Joaquin Local Health District. (signed) ----- --------------------- -----------------=----------------- ----------- :------ .(�f-�nd/or Contractor) I ) - Plot . lan, showing-'siis of lot, location of s stem.in�riao, wells;"6uildin-`-- - - --- (Title].___.__,_-.___.-_._.'__.....................Y:----y( p g ' ygs;etc.—,- be placed on reverse sid'ej.'-`-' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --- ---------------------------------------- DATE-----�--Z_-'/--G- --------------------------- REVIEWEDBY__`---------------------- ---------------------------------------------------- ------ DATE------------------------------------------------------------ BUILDING -------------------- - BUILDINGPERMIT ISSUED------------ ------------------------ -------------------------------------------------------------- DATE------- ------------------ --------------- ------------------ Alterations ----- ----- Alterationsand/or recommendations----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ } t f ---------------------------:t-------------c- -------------------------------------------------- -- _ I _____-.-_-____________________________ ______________________________________________________-__._.__-__.______--____.___._ I _ , _.. .� ►._ _. 1 4, _d FINAL INSPECTION IBY::... '--- �'..+ 4---------- Date ----- --- -- --------------- SAN.JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street € Locli,.California Manteca,California _�_�_�Tracy,•California — — Stockton,California —� .._.� ES 9 REVISED 9-59 3M 3-163 F.P.CD.