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OROFFICE USE: --- -------------- Permit No. ..... ;IL .__.- - tr APPLICATION FOR SANITATION PERMIT -------- (Complete in Duplicate) Date Issued mzh ------------------- 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. ' JOB ADDRESS AND OCATION------ _ ___-L�` - -°•• Owner's Name--- •_ L�'L-T ---- Phone------------------------------- Address------- ---- --------------------- Contractor's Native_-.- Phone Installation will serve`Residence 2`�Apartment House [ICommercial E] Trailer Court ❑p Motel ❑ Other ❑ Number of livi'g units: -. - Number of bedrooms Number of baths _--_- Lot size -11 Water Supply: Public system ❑ Community system ❑�.�Private Depth to Water Table At7 ft. �''t 1 .%, ti"44 1 Character of soil to alciepth of 3Yfeet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (lf yes,date-.---------._-..---1 No [� New Construction: Yes ❑ No FHA/VA: ,Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or' cesspool permitted if public sewer is available w in 200 feet.) Septic Tank: r Distance from nearest well-----------------Distance from,.foundation-------------------.Material----------------.--__---------------------------- ,. 0d�'f�e No, of compartments--------• ---------------Size------------- . =�--------Liquid d pth -, apacity `r �P.---_.._-Disfance'to,riearest lot line-.$-_._ Disposal Fiel�4: Distance from nearest well-AW Distance from foundation.__ __ f ------- ��yf Number of lines---------- Length of each•-Iine---1jW.-....�-_--_.--Width..of trench..,A- ----------------------- r Type of filter material-/ -Depth of falter material Total length_- /f Seepage Pit: Distance to nearest well----�, e------Distance fpm founda#ion----------------_-..Dist `ice to'nearest lot line--e ----------- our -.__-..- Number of pits..--.�-------------Lining material----/�--f- -.-Size: Diameter.-�� .:---___- x- i ---------------- Cesspool: Distance�from.-nearest,well-___- --------Dist foundation __-_---- --_-.,_--Lining,material---------I-----._-__--------------. __-JJj ❑ Size: Diameter------ -------------------------------Depth-------------- ------------------------------------Liquid Capacity—---;--------------------gals. 60 Privy: Distance from nearest well-------------------------------------_--------.-Distance from nearest building-'- --------_-------_----__-------------- ❑ Dlistance to nearest lot line------------------------------------------------ ---------------------- ------------------------------------------------------------ --------- I Remodeling and/or repairing (describe):----------- - ---------- ------------ ;5}.__�. I ---- ------------- ------------------- ------------ ------_-..------- --------------------------------------------.-------------•----.------------.---------------.--------•------------------------------------------------}------•- ------ -------------------- - --r -=- -•-----------------------------------------------------------------------------------------------------------------------------r----------- 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, an rules and re lations of the San Joaquin Local Health District. � ontrac (Sign51 ned -------------- -- ---- ------------ -- ----- - -- --------------------------------- -----(� tor( ed) --------- - -- ---- t By:----------=--------------------------- ------------- ---------- --------- I ----- --------------(Title)-- ---------------- ------ (Plot plan, showing size of lot, location of system in rel • n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- !___ Com==------------------------------------- DATE------- -1- -- REVIEWED BY------------------------- ------ ---------- --------- ------ --------------- ---------------------------- DATE BUILDINGPERMIT ISSUED------------------------ -------------------------------- --------------------------- --------- DATE---------------------------------- --------Zz�------- Alterations and/or recommendations:-..-_ -�*-- `-------/�=�- y ` �1 --l� `� - .;: 1 '� ------------------------ --------------------------------------------------------;---------------------------------------I Y i -------- -------------------- -------------------------- -------------------------- Y y Date--------� �� FINAL INSPECTION BY:-.-- ,........ .. ....Gr-=�-�� / SAN.,JOAQ.UIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street. 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r,S 9 REVISt:d B-59 3M 3-'63 FrA-00.