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-UK UFFICF�JSE: g }T -'__ _ APPLICATION FOR SANITATION PERMIT Permit No. ..:.;. ----------------•------------------------------ -------- (Complete in Duplicate) ------------ -----'----- ----------- --------------- --- This Permit Ex ires T Year From Date Issued D to issued � s-- Application is hereby made to the San Joaquin Local Health District for a permit to construOJI insl�ff thwvork herein described. This application is made in compliance with County Ordin nce No. 549. �6,l JOB ADDRESS AND LOCATION_ ----- ------ -------------------------` --- -- Owner's Name___ ._ _ _ - ----------------------- - Pone---••-----•-•----------------•--•--- Address------------------------ ---•-- - `j� ---------------- ------------------------------------- Contractor's ------------ Installafion will serve: Residence [] Ile Phone. Contractor s Name � �. 1 - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court p Motel i � ,� � ❑ Other ❑ Number of living units: -------- Number 6ofledrooms "-_^-Number of baths _______- Lot size ------- I Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy.Loam ❑ Cla'y am ❑ Clay ❑ Aid be [/Hardpan ❑ Previous Application Made: {If yes,date. ___________ No [&---New Construction: Yes B +5o ❑ FHA/VAt Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -0 (No septic tank or cesspool permitted if.pubiic s veer is-available within''200 feet.) Septic Tek: Distance from nearest well--+�O-.____Disfance� rom foundation__ ___ ` �iL�: `-pJ'u.� 5// r Material No. of compartments_--- --------"-*- Size---....-._•-----X- �/Liquid.depth------- --------------Capacity-2.?o- Disposal eld: Distance from nearest well -40_. Disfance from foundation_-/4- rtit __.Distance'to nearest lot IineS__.__ Number of lines_____ Length of each _ iIine_I-4VO__�1____:_____-."___.-_--Width of t rexnType of filter ---Depth of flter maferial___- ,�.- "_----Total length --"-c"--iii-.--._-_--.-P------l-i-n-See e Distance to nearest wel__4Q40._9_ Distantm 9undafion______ __._ .Distanse toneost lot of pits---- ,---�-/- Lnin material_ Q- ----Size: Diam�er_____3 ' _-_--- -- +-c Cesspool: Distance from nearest well_________________Distance from foundation Privy: ❑ Size: Diameter------ -- - ----- Depth------- , ---- ---- ---- -----�iquid !Capacity- ------- -9als Privy: Distance from nearest well Distance from nearest bug---ildin -------) - ---------------- --------- ❑ Distance to nearest lot line-------- ------------- -----------E -. I -------------------------------------------}------- :• ri Remodeling and/or repairing (describe)--------------------------------•--------- ,` i -.1----------------------------------- S -• --------------------------------- - l �. --------------------- ----------------------- ------ --------- -------------------------- ------------------------ -------------------------------•---------------- !------------------e `` = t--- I hereby certify that I have prepared this application and that the work will be done in accordance witWSan Joaquin County ordinances, State laws, and rules a regulations of the San Joaquin Local Health District. (Signed) 0 By� ---------------- ---�(/-- --- - _er and/or Contract wn o or} � • -- ------(Title)- �.`� (Plot plan, showing size of lot, location of system in r tion to well', buildin s, etc., can be laced or rev re side). WR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...-....... . --- '----- ---------------- DATE----- 1C 1 -` REVIEWED7 BY ------------- ----- -------- ------------------------------------•--- DATE - - BUILDING PERMIT ISSUED------- -------------------------------------- tions:.-- -- ------------------------ DATE- = E ��-�� ........... .3-�c� ---- �- -----C� —S --------- "�''` .-1 c- ---�.------ ! Alterations andor recommendations --------------- --- ----- Y„� _ r= ----- - ------ ---------- - ��J'z --- r ` ------------------------------- -------------------------------------------- ----- ----- ------- --------------------------- FINAL INSPECTION BY:--------- / 6� ` '~`---------- Date....---------- { -------- ---------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT -' 1461 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street y ,r ti 205 West 9th Street Stockton,California Lodi;CaliforniaS . . = Manteca,California i 4 Tracy, California °