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I FOR OFFICE USE: ! i i ------_-------_� APPLICATION FOR SANITATION PERMIT Permit No. .. ------- . 6T l �-------------------------�!------- (Complete in Duplicate) / - -----------------------------------------------h�-. __. This Permit Expires'l Year From ©ate Issued Date Issued ------- Application _____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 irillcompliance with County Ordinance No. 549. JOB ADDRESS AN O I A ION------�, _._ ------ Ate ` -_ Owner's Name ------- ------ -------------------------------------------------------------------- -------------- Phone-------------f-----t-- tw / Address................• ------+--------------------- Contractor's Name / - ------------------------------------------- -----------------------•---------•----••--- Phone.................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ IIS' ___ r Number of livingunits: _ Number of bedrooms __ Number of baths _ Lot size __. di .. Water Supply: Public system E] Community system El Private [a�ISepfh to Water Table f� r Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam L] Clay Loam E❑ Clay E] Adobe ardpan F-17 Previous Application Mad : Ilf yes,dote----------------_-.) No ��New Construction: Yes E] No ��FHA/VA: Yes El ® No P TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) t ! Se ic Tank: ll . / Distance from nearest we _________-_ l- ' ____Distance from foundation____________________Materia __ __-______- _____._ yNo. ofl�compartments-------------------------Size-----•-------------------------Liquid dept------------------------._Capacity----------------------- Disposal F'e�ld: Distance from nearest well._y��.-._Distance from foundation___-(?�.-ZO_.___._Distance to nearest lot line._ ----------- Number -____. Number of lines_____- ? ength of each line�V._--' VCrn,4__Width of trench_.____ ' ,li �i Total len th__/ i r l r Type i�l filter, material_, -Depth of filter material__��-_-_ `�o g �_____________-.___'_-_ 7` - '� Nil Seepage if: Distance to nearest well_-_,��47__Distance fr fou dation--AX-O--____-_Distance to nearest lot lin---� --- O Numb& of its___. __ ____-.Linin material_-- _ Size: Diameter .. �. De '' �r P g -- pt�� 111 Cesspool: Distance from nearest well---------- from foundation------------ material:_____--._.-___.____.____._.________. ,L x + , -9 ❑ Size: fiameter---, -------------------------------Depth--------------------- --- -- ------ ------Liquid Capacity------------------ - -----gals. A Privy: Distance from nearest well------------------------------- from nearest building_.-____----------------------------------- a F1Distance to nearest lot line ----- _-""---_--_------------- Remodeling and/or repairing (describe):------ ---- ----------------------- -------------------------------------- ----------•-•----------------------------- 1I1�------------------------------------------- --- ------------------------- i -------- -- ---- --------------------------------------------------------------=-------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that li have prepared this application and that the work will be done in accordance with San Joaquin County iordinances, State laws, an rules and regulations o file San Joaquin Local Health District. (Signed)-------------------------- ddII� -- - -- -- ----- - ---- - -------------- ---------------------------- --- --�or Contractor) B �I-� - -- -(Title) L (Plot plan, showing size of.lot, location of system in r ton to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ----------------- ------------- ' -�--- •.- -- ------------------------- 'DATE------ -----�--`c_ ---------- - REVIEWED BY--------------------- --------------------- - -- ) = �7ATE " -------------- ----------------- BU I LDINGS PERMIT ISSUE!` ==----------------------------_------------- - ---------------- DAT r Alterations and/or recommendations:______-.__ f'_-_-.- ~` _____ ._ __ __ - ------ '--------------------------------------- ' -----•-------------------------------------- -------------------------- - - ---------- -- -------------------------------------------- ------------------------------------- ------------ FINAL INSPECTION BYi:. C.c2��,_-_ Date__.....-___- ~---------------- ----- --- ---- f.. SAN,JOAQUIN LOCAL'HEALTH DISTRICT 1601 E.Hazelton Ave! 00 West Oak Street 124 Sycamore Street k 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.co.