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FOR OFFICE USE: ------------ --------------- / --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .L..........-...: -- ------------------------------------------------ (Complete in Duplicate) S ----------------- This Permit Expires 1 Year From Date Is to issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal the work herein described. This application is made in complianje/with County Ordinance No. 549. L !s b / JOB ADDRESS AND LO ATION- )M.�. r � '`-- Owner's Name --' -------- -- ---- -- - -- ------------------------- ---._. Phone -------•---•---- _...-- f `� ------- ----------------- Address •------------------------ -------- ------------------ ---------------------------- -•-•--------••-- :.. 1 r ;� .- 4 Contractor's Name----- ------- c- ------------------------ Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.f-- Number of bedrooms - -- Number o baths �__ Lot size __ _______.__,__ Water Supply: Public system ❑ Community system ❑ Private Depth to ater Table -------- ft. , i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ - Adobe ❑ Hardpan ❑ Previous Application Made: lif yes,date---__-------------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 3 TYPE OF INSTALLATION AND SPECIFICATIONS: ` (N septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well---_?,IQ -___Distance from foundation-----/i0-----__Material_______________________________ _- � No. of compartments_.----'_-----...___._ _-.-_Size__1..- __ -- 1�-Liquid depth__. -----------------Capacity a Dispos geld: Distance from nearest well---c:50_ -__Distance from foundation._Z6_____-_Distance to nearest lot line___„��_.___..... Number of lines---------- j.______Length of each line____`�Q__f______________Width of trench ---- ------------------------- Type ( • �� Totallength- r --------:--- YP f-- P T e of filter- material_ __ __ De th of filter material______ ___ Seepage Pit: Distance to of nits rest well. Lining material Distance from foundationSize Diameter 7, El I— of line I—- .__ ❑ P g ------------------- Cesspool: - Cesspool: Distance from nearest well-----------------Distance from foundation------------"--_'Lining material-------------------------------------- ❑ Size: Diameter----------------------•........--.----Depth-------------------------- ------------------- •....Liquid Capacity--------- ------------------9als.� -Distance fromnearestbuildin Privy: Distance from nearest well-----'-------- - ------------------------- g------------------------------------------- Distance - ------------------------------------Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------- --------------- -------#-------------------------------------- -----------------------------------------------------------------------------------------------•----...-------------.--- --•-•----------------•-•------------------------------------------------------------------------- --- t 1 ----------------------------------------------------------•------------------------------------------------•------------------------------------•------------------------------------------------------------------------ - - 1 hereby certif �at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aww )and rules and regula io s of the San Joaquin Local Health District, (Signed)-------------- ----- T - --- ----- ---------- ---------------------------�" - -* ------- "mer T, _ _ - Title - -- an (Plot plan, showing size of lot, location of sys em in relatio to walls; buildings,.etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ---- ----------------------------- DATE---- --------_--------- REVIEWEDBY-----------=--------------------------------- ------------------ ------------------------------------------------------. DATE-------------------------------------------------••-------- BUILDINGPERMIT ISSUED---------------------------- "---------- DATE.------------ ----------------------------- Alterations a /or recommendations' �`/�',� --✓`-`--`��'`-----�- -- -- C- -- •4 `�' ?ms 's--'��t.A c��c �i-t --E_ �-1 - --------- ------ ------- --' ----- --- — ----------- -------- ----- - ---- - ----- ----- ------ ------ - -- -- "FINAL INSPECTION BY:.--------�_._`--------------- ---------- ---------- --------------------------------------- ------ ------ ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street' Stockton,California Lodi,California Manteca,California Tracy,California r ES 9 REVI5EO 9-59 3M 3-'83 F.P.CG.