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FOR OFFICE USE: a-via-----��.�� ---------------------- ...__..��-_-____-_-"..""."_----__"".... APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- ------ ------------------------ {Complete in Duplicate} Date issued ---------------------------- --------------------------- This Permit Expires 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. This application is made in compliance with County.Ordinance No. 549. CATO � - ---•---------------------------------JOB ADDRESS A Owners Name-------- - - ----------------•--------------- --------------•----------------------------------------.-. Phone----------------------------------- ---------------- -------------------"---=----------•--------------------------------------------------------------- ------------ -•---------------- Phone----------------------------------- Address ------------ ---------------------------------------------------------Contractor's Name Installation will serve: Residence RK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ -Other ❑ Number of living units: I--- Number of bedrooms Number of baths --""" Lot size. _"--."."""""_ Wafer Supply: Public system ❑ . Community system ❑.. .Private Imoe 6epth to Water Table ao ft. Character of soil to a depth of 3 feet: Sand C-] Gravel ElSandy Loam ❑ Clay Loam F-1Clay ❑ Adobe Z1,-11ardpan ❑ Previous Application Made: If yes,date.. . ..... .........) No ' New Construction: Yes El 'No HA/VA: Yes ❑ No ®,... TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s.. Septic, Tank: Distance from nearest well_____--"--------_Distance from foundation--________________.Materia!-""".."."-"-_-_.---------.-.-_-___._-.-.-__-_-- Rti19�GyNo. of compartments-------------- ----- ._.__S-ize---------------------------- ---Liquid depth----------- -- - -------- Capacity-_..------------------- Disposal Fieldr s#Distance from nearewell O-"..'Distance from foundation_- __.Distance to nearest lot line-_ _�.____ / ter JG Number of lines._____ _ __ Length of each line___ r _ _._ Width of french_,oZ_/------------------------ /t fr f j Type of filter material.; . .t��Depth of filter matenal___��_.__.____.To#al length---oz_p____________________________ Seepage Pit: Distance to nearest well`,__..494P_-_--__Distance fr m foundation____��_._�Distance to nearest lot line_.• ._ _______ Number of pits--_- __-----_A-""Lining material_ _.._ . ��4474/10 -Size: Diameter--S�3._-__-____Dep#h�,�`___-------------------- Cesspool: Distance fi-om nearest well i_______----.__Distance from foundation--.---------------- Lining material------------------------------------- Size: iaeer--------------------- �-----_..Depth-. ❑ SDiameter p ------------------------Liquid Capacity -----------------------gals. lDistance from nearest building ' Privy: Distance from nearest well---�=------------------------------------------- ----------------------------------- ❑ Distance to nearest lot line... -- ---------- ---------- ----------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)------------- `---------------------------------------•---------------------- ------------------------------------------------------------------------------•--------------`----------------------------------------- -------------------------------------------------------- ---------- I ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ----- --------------"__"---------------------------------------"------____--- __---------_-_-----___----"----:-------"_______.--------__.---.----...-".------------...__.._-"--------------_...._.- I hereby certify that I have prepared this application and that the work will`be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i , {Signed} =t ' -- - {� +"yCont +or) S --------------------------=-------- "�•.-------------(T+1e}- ------------------------------- --------------------------- - = Y:--- t r (Plot plan, showing size of lot, location!of systerriin`re on to wells, buildings, etc., can be placed on reverse side). .. y... fF VEPARTMENT USE ONLY f APPLICATION ACCEPTED BY............ . . .... . - ------ --------------------- DATE------42-r ' � --------- ---- -------- --- REVIEWEDBY----------------------------------- -- - ---------- ---------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------- -------------------- -------- ----------------------------------------------- DATE-------------------------------------- --------------- Alterations and/or recommendations: ------ -- ecommendations: _-- ----------------------------------------------------------------------------------------------- r --------- --�- ------------------------------------------------------------- ---------------------------------- ---- ----------------•----------------------------------------------------••_------------------ --------------------------------------------------------- ----------------------- -------------------------- ------- ----------------- - ' -------------------------- --•---------------------------- ------ -------------------------------- ---------------------------------�, FINAL INSPECTION BY: ------ ---- - r ------------- Date---------f-0----/9----4/-------- SAN JQJK 'UIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CU.