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FOR OFFICE USE; • ......... APPLICATION F"OR SANITATION PERMIT Permit No. a�/.. ~ -- ---- ------ a --------'-------------- - 4 (Complete in Duplicate) -- ----=--- -- -----'.-.- This Permit Expires I.-Year From Date Issued Date Issued 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 Ordinapce No. 549. rf JOB ADDRESSID LOCATION___--- Y!�= _. - ---- ----- --------- Ott Owner's Name _YV - - _ � cfP Phone' Cr��f'.�- (�- � ------- --- ---------- -------- ------ Address._ L? --- - -•••-�- --!�� z // Contractor's Name------ ----- ------ Phone-7 44� "`3-/yZ �/ ��-•. pp Installation will serve: Residence [j Apartment House E] Commercial [:] Trailer Court E] Motel El Other L� -N=4Le Number of living unifis: -------- Number of bedrooms -------- Number of baths -- ----- Lot sizeC2 5.-,�--� l-11------------------------ Water Supply: Public system ❑ Community system ❑ Private [IR-IDepth to Water Table�dit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®---H-ardpan ❑ Previous Application Made: (If yes,doter V1.aP----) No ❑ New Construction: Yes [�F] FHA/VA: Yes E] No F-1TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) phi ank: Distance from nearest well-----------------Distance from foundation-------------------.Material------------------------------..-------.--.-----. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity---------------------- Disposak Fie d: Distance from nearest well..--- Distance from foundation.--Rea....--.Distance to nearest lot line�?_.- Type of of lines___...--__--.--- ------Length of each line-�p ..:_.._,r---...Width of trench--__ V.___ Number, �Ifilter material.a�_-t_ - 0�R-.-Depth of filter material---, -__-.--.-Total length--------- .e-40---------- I Seepage Pit: Distance f r� 1 �x to nearest well-Av-----..----Distance rom foundation to nearest lot line-J-------- �`'�� LTJ Number. of pits---�--------------Lining material- G --- Size: Diameter---- ---------Depth----.U----�T-------.-.------ Cesspool: Distance from nearest well-------_--------Distance from foundation material--------- 0 ❑ Size: Diameter----- ;- ---------------- -------Depth-- -------------------------------------------Liquid Capacity-------------------------..gals. F Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------..-------------------_--.--.----_. s i t ❑ Distance to nearest lot line ------------------------------------------------------------------------- ---------------------------------------------- ( Remodeling and/or repairing (describe) ------------------= -------------------------------------•------------------- ------------------------------ -----• Vpi f -. F` ---------- ------------- ---- -------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------.-- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and'rules and r ulations of the San Joaquin Local Health District. " �i (Signed)------ -------- - � (O ner and/or Contractor] By:--------------------•--------= ----------- ---- -- - -- ----- --- - -----------------------(Title} - --- -- --------------- ---- - - - (Plot plan, showing size of lot, location o system in relation to w s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED,BY- ---- C/ - --------------------------- DATE----------- l1� ---------- REVIEWEDBY---------------•------i------------------ -r---- ----------- ----------------- ------------------------------------------ DATE BUILDING PERMIT ISSUED- :---- a Alterations and/or recommendaf ions:------- 7c�°. '�% ...--- _-- ---------------------------------------------------- --------------------- -------------------------------------------------------- --- --------- ---------------------------------------------------------------------------------------------------------------- - -------------------------------- - ------- - ------ -------- -------------- - ---------- - --------------------------------------------------------------------- ------- - I FINAL INSPECTION BY:. ---�-�- � � ---------- Date...----- -------------------- - - ---------------� SAN JOAQUIN LOCAL HEALTH DISTRICT f 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street � Stockton,California Lodi,California Manteca,California Tracy,California�r r.p.CO. A ! .i