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VUR UFFICE USE: -------------------------------------------- APPLICATION FOR SANITATION PERMIT ' Permit No. .. L.(�. ------------------------ --------------------- ---------�---- f (Complete in Duplica+e} . . _„� __ ------ - - - nk -, hi' t _ �.. ..Date Issued �f�� „ -*This Aermit Ex' fres il Year From Date Issued Application'is'hereby made�fo the San"Joaquin Local Healfh District for permit to construct and install the work herein described: This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION_ ---5--y YJLv_ - _ r Owners Name p -- o ,-.: p � ---- -- - -- - -----------=- ------------- hone-----------•-------------------..._-4. Address---------- - --- - -- ------ ---- ---- - ' .:_ ; ---- ---••- ---- ------ ------------ --- -------- - ---------------- Contractors Name------ --- s ----•---- ---- . -- -- -- -------------- Phone----------------- { Installation will serve: Residience" Aparimenf ouse ❑ .Commercial ❑- Trailer Court ❑ Motel ❑ Other ❑ ' Number of living unitsoll : _._... Number of bedrooms,,Z_ _Num6er. aths -Lot Lot size __ Water Supply: Public-systerri�❑: CommEi ity system ❑ Private Depth to Water Table .. ft. �.,I, 67 Character of soil to a depth kof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑„.Clay Loam ❑ Clay Adobe❑ Hardpan Previous Applica+ion Made: Illf yes,date_..............._-1 No E] New Construction: Yes E] No ❑ FHA/VA: Yes ❑ No ❑ s ,F TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic--tank or cefspool permitted if public sewer is available within 200 feet.)a r .� I _ .Z- _ _ Septic Tank: Distance,.from nearest well_-"-_"_-_-----_"'Disi•ancfrom 'foundation_ ------------------- Material___-___.".__._.____ i ❑ No. of compartments---------------------- Size I ---------Liquid depth-------------------------Capacity-------------------- Disposal Field: Distance!Jrom nearest well---------------- Distance from foundation,-------------------Distance to nearest lot line_____Num ____________ ❑ ber of fines-----------------------------------Length of each line--------- ------------ Width of trench Type ------------- T e of-filter material--------------------------Depth,of filter.material---_.___-.__"_______"_Total length_______________________________ ----------- $eepa it: Distance,'to nearest well---___'e. -@_�--Dista e from' ndation----IQ._f_____.Distance to nearest lot line _' ` f 1 Number of pits-.._"-_/-------------Lining material,.-- _. - - _ .._.Size::Diameter--------�:.rl'q #h.De � p ?= -------------- Cesspool: Distance hfrom nearest well-----------------Distance from foundation_- "_-,_.___"_-.Lining material---------------------------- ❑ Size: Diameter-----------------------------------`--__Dep th=--------- Liquid Capacity 9a Privy: Distance„from.nearest wall _----------------------------------------------Distance from nearest building _ ❑ Distance to riearest lot Line______________.____-___. Remodelingand/or repairing'an / p 9 (describe): - ------------------------------ ------------------ -: n ,-----•--•-------------------- -----""--••------------------------------------------•----•-------"---------------------------------------•------------------------------- ------------- ----••--------------•----------------------- -----------------------------------------------------------------------•--------------------------------- I hereby certif hat I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, Sta aws and rules and regulations of the San Joaquin Local Health District. {Si ned 9 .} ---- - _—.; -- ---- ------------------------ ---------- r-...K- . $y:. �+... --------------------{Title}----------------- or-Contractor) on aO'' �"� (Plo# plan, showing size of lot' location of sys+em n relation to ells, buildings, etc., can be placed on reverse side). .4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - -- --------------- - ---------------------------------------------------------- DATE---_ - ------------- REVIEWED BY--- --------------------"--------------- - -- - -------- DATE - --------------------------- - BUILDING PERMIT ISSUED---`-'---------------- ----------------------- ----------------------------------- DATE- ------------------- -- --Alterations --------------------- and/or recommendations:__.-"...---------- ---------------------------------------------------I---------------------- .........".."-___"".".--..-_--___"_______________________ _____"_--"-_-_".-_--._. ----------------------------------•- -----------------11--------- - ------------------- - -------- --------------.......................t------ FINAL INSPECTION. BY-- - --- -- -- --- ------------------ ---- ------------ Date._U_._`! �' a SAN JOAQUIN LOCAL HEALTH DISTRICT 1661 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 0-59 3M 3-'63 F.P.CD. i