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FOR OFFICE USE: � ----- --- _----------------- APPLICATION FOR SANITATION PERMIT Permit No. -------- --------------- ---------- ----------------------- - te,in(Com P. _le ✓„ �J r �Duplicate) R---� Date Issued -----;--�---,-�--� ----------------------------- ___-. ____ ___ This,Oermit Expires l Year From Date Issued r Application is hereby made to the SanJoaquin Local Health District for a permit to con truct and install the work herein described. This application is made in compliance�wi Courty'Ord' ante No. 54 . � ZI "l " .- . -"'- e- t ---------------------------------- 0, ---- -------------------------- I JOB ADDRESS AND .0CAT1ION_______;> Cz _ ___ _ __ �. Cw---.---- 4 ► s: Owners Name ��. ---- 4 ---- ---------- -------------------= -- Phone__t ------- I Address_....... ` � r -•c•` --- -( Contractor's Name------- / ------------ a,r--- ---------------"_ ........ Phone.��q�0`7._ Installation will serve: Residence f% Apartment House ❑ Commercial ❑ Trailer Court ❑ iMotel ❑ Other ❑ S &o Number of living units: -" Number of bedrooms fQ^ Numbernof,baths . ___" Lot size ___ -";"-""---?�---- t -Q__.............. r Water Supply: Public system"'❑ Community system ❑ Private. Depth to Water Table _ems ft. Character of soil to a depth of 3 feet: 1 Sand N Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------_..... _) No K New Construction: Yes ❑ No Ur FHA/VA: Yes El No a r TYPE OF.INSTALLATION AND SPECIFICATIONS: } ..(No septic tank or cesspool permitted if public sewer is available within 200 feet.)-. est well________'_____.__Distance from .foundation_______ Material________. ________________________________ Septic Tank- DistarIce from near __Size___________________________ ___ Liquid de th__. ____Ca Capacity � No. oftcompartments------------ -�• - - q p -------------- p Y----------------------- O Disposal Field: Distance from nearest well-__�5�1.-._Distance from foundation___-_.-iZ9-_____.Distance to nearest lot line___&,.___.._ Number of lines-------------I-------------------Length of each line --------- P!____-__---Width of trench------------ ......---.-....... QLAA Type of filter material____./_f71_-ALof filter material_______1 �'-__-Total ' length----------------/�la_.�.-__.____. Seepage Pit: Distance to nearest well.____________--------Distance from foundation____________________Distant ti nea�rdst I�ot i'fne=_______________.� F ❑ Number of pits----------------------Lining material------------------ ----Size: Diameter-------;---------------.Depth--------------------------------- i ,� Cesspool: Distance from nearest well____.___'.____.---Distance from foundation _____________.Lining material___.__-_._________"-______.____-_-_. ❑ Size: Diameter----- -------------------------------Depth- ---------- -------------------------------------Liquid Capac�y Priv Distance from nearest well---___.' bistance,from'nearest building_-__ `C Privy: ------------------ N ❑ Distance to nearest lot line"------=---------------•--------------------------------------------- ---------------- ----------------------- ----------------------------- 3 Remodeling and/or repairing (describe): �._. ------ 70-1---- 1/�l�- / '� --------- --------------- --•=fes -- ------ - - --- - - - ----- -- -•- - - ------ -- -- -••- ----- � ----- -- - -. -- - --- .--. y` ------------------------------------------------------------ hereby certify that I have prepared this applica+ion 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, t 9 t--------------------.Owner and/or Contractor) - _ r -sy�- = (P � lotpan.,hing size of lot, locafian f sy em in relation,to,wells,.buildings, etc., can bra placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------------------------------- ----------------------------------------------- DATE°------------------------ REVIEWEDBY------------------------------------- . y.. -- ------------ DATE------------------------- BUILDINGPERMIT ISSUED_-------------------------------------- ------------------= __ ATE------------------------------------------------------ ----- Alterations and/or recommendations------------------------------------------------"------------------j---- -------- ------------------ ----------- -------- ---•----------------------------------------- ----------- _. " ----------------------------- ------------------------------------------ ---------- --------------------------------- -----------•----------------- ------•---•-------------------------------•-----------.._. -------------------•- --------------------------------•------------ -------------------------------------------------------------------------------•-----------------•---:--------------------------------------------------- t ----------•-------•--------- --------------------•--- -----= .... ._....._.. ------ -------- --------------------- -------•-------------------------------------------------------- i _ FINAL INSPECTION BY:___._._.___..:. �.. =-_____ ------ F1 w �� ------ ----- - Date --- ----- �� i � SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i ES 9 REVISED B•59 3M 3-'63 F.F,CD.