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FO OFFICE USE: ft -�------------- Permit No. 6- APPLICATION FOR SANITATION PERMIT �-� -------- (Complete L Com late in Duplicate) J ?- --- ----------------------------------------------- ( P P Date issued ----- ---- -- _ - This Permit Ex fires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein de •rbed. t This application is made in compliance h oun Ordinance No. 549. ----------------------------- ¢ JOB ADDRESS AND LOCATION----- -- --------- - --------------------- --------------------------- ------------------------ - -- -- ----- Pho - �-77 ' Owner's Name----��- -------------------- - -- -- -- -- ---------------- - •- ----•----p--- Address----•-----------•-_ _ ----------------- --- --- - Q - --- ------- - --- --------• -- --------- ---- �� (cam\�-�.'�,J`�- --- -----------I—------------ Phoro 0_1 Contractor's Name- - Instaliation will serve: Residence Apartment House ❑ C'o'mmercial ❑ Trailer Court [I Motel [I Other [3__ Number of bedrooms of baths _- __ Lot size _ .�� "` '�- t Number of living units: -� N - Water Supply: Public system ❑ Community system ❑ Private*---8'epfh to Water Table (O- ft. Character of soil to a depth of 3 feet: Sand ❑ G vel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ I Previous Application Made: {If e"s,date_-- __ 9- 1 No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ + Y �� TYPE OF INSTALLATION AND SPECIFICATIONS: { [No septic tank or cesspool permitted if public sewer is available within 244 feet.] is Tan istance from nearest well-----------------Distance from foundation--------------------Material__-.____---------- ----------------------------- Size ------------- Liquid de th-- Capacity No. of compar}meats___________________ _ - is oral F• ld: istance from nearest well/"__.-._DNstance from foundation_________.___.___.Distance to nearest lot Ime___ _ - ______ !f Number of lines________ Length of each line __ .Width of trench- :__---------------•-- Type of filter material______ -Depth of filter mat erial----- ._- 1--- otal length-----------.3 0 a e Pi Distance to neares well_ _Q -._--Distance om oundation_ �.-- istance to nearest lot line----- --- p g ------ Size: DiameterDepthr Number of pits_- I--._-__----____Li ng mater+al__ ______ ___ _ ----- r------------------ Cesspool: Distance from nearest well-----------------Distance from foundation-___�____.-------Lining material_________________________""________.X7 ____-.Liquid Capacity-. gals. 11411 ❑ Size: laiameter--------------------- ---- ---- Depth_ --- - ---- ------------------------ - q p Y- ------------- --------- Distance from nearest well-------------------------------- Distance from nearest building--------------------------------_._____. Privy: C ❑ ----------------------. G Distance to nearest lot line------------------------------------- -- Ilk ___-_.___ -------- ------------------------------------------------- � Remodeling and/or repairing (describe): ------------------------- ---- ---------------------------------------------------------- �- ---------------------------------------------------------- - --------- ,�''-------------- -- -------- - ------------ ------ I hereby certify that I have prepared this application and that the work will be done in 'accordance with San Joaquin County k ordinances, tate laws and rules and regulations of the San Joaquin Local Health District. ac 5t ned r_ -end �ontr tori --------------- itie]--------------------------------------- - -- -- - --- "-- --- By: (Plot plan, showing size of lot, location of system in relation to wells, uildings, etc., an be placed on reverse side). FOR DEPARTMENT USE ONLY -2- E Z� APPLICATION ACCEPTED BY =---------------- DATE---------- ----- --- ;l _.- - ------ --------------------------- --------------------------------------.DATE BUILDING PERMIT ISSUED-----------------------e -"/----------- - ----------------- -------N---------- -DATE � ----•--- --, " Alterations and/or recommendations_____________ ----------- , -------------------------------------------- --------- ---------------------------------------- ---------------------------------------- ------------------------- FINAL INSPECTION BY:....... Date `-- ---- ---------=�-- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CC.