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FOR OFFICE USE: ------------------------------------------------------- - �� S APPLICATION FOR SANITATION PERMIT Permit No. .......................• ` + (Complete in Duplicate) I--------------------- This Permit Expires 1 Year From Date Issued Date Issued .______�............. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application s made in compliance with County Ordinance No. 549. JOB ADDRESS A ------ - --------- -- t Owner's Name--I- - -- ---------f ----- - - ------------------------ ------- Phone---------•--------------•---------- _ Address ; -------------- ----- ------� `' .._.. -------------- _ Contractor's Name-------- c / ---11 ----- ----- -.... Ph ---------------- one Installation will serve: Residence [Apartment House E] Commercial E] Trailer Court ❑ Motel Other ❑ r a Number of living units: __ ._ Number of bedrooms _.umber of baths /_.__ Lot size _____ _._ ----------------------------- Water Supply: Public system ❑ Community system ElPrivate [Depth to Water Table -------- ft. Character of soilto a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam Clay ❑ Adobe E] Hardpan ❑ Ii Previous Application Made: (if yes,date-----...............I No F-1New Construction: Yes ElNo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _(No,septic,tank,or,cesspool_permitted_if,public..sewer is_availabl.e within 200 feet.)_... -_�,: Distance' from nearest Distance from foundation--------------------Material------------------------------------------------. Sep t❑ic Tank: No.. of compartments- well------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- �. Dispos Field: Distance from nearest well-.__.-�_�.._.Distance from foundation-----lgg�.........Distance to nearest lot line---q----------- Number of lines----------I--------------------Length of each lire------l-d--0...._..._"__._.Width of trench-----x--------------------------- Type of filter,material--------S.RI.-------Depth of filter material____.-&............Total length_-_1 Ra__/_____________________.___ 96 M IP f .seepage-Pi Distance to nearest well------/?4........Distance from foundation""__ Distance to nearest lot line-_ ---"""-_._ [] Number of pits.-------E------------Lining material--------W ----Size:eEFrcr te#er-- -� ./D-�__-Dept ------------------------- Cesspool: I Distance from nearest well-----------------Distance from foundation_._._"-.._ _��; Lining material-- -----.------------------------ .___ Size: Diameter------ ------------------------------ Depth--------------------------------------- :__--Liquid Capacity--- ------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from 3nearest building----------.----..____..__._._____.._-..-- ❑ Distance to nearest lot line-------- - ------------------ --- - -------------------------------------[-------------------------------------- ---------- -------------- Remodel ing`'and%or -------------Remodeling`'and%or repairing (describe):-- --- -------------------1------------- -------------------•--- --------------------------- 1 ---------------- -ol--,--- _ ----------------------------- ----=----------------------------------- --------------------------------------------------------------- I -----i-------------- -------------- '- - --------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will Se,done in. cordance,with S'awljoaquin County ordinances, Smfzaws, and rules and regulations of the San Joaquin LocW-Health Disrict. (Signed)---(i� ---�------ ----- --- - - ----- -------------- ----------------------------------------------------------------------------- -- and/or Contractor) _ r - ---------------------------Title --------.- -- --------------------- - ----- By _ _- - --- - - --- ------------t—®rm -- - -- (Plot plan, showing size of lot, location of sy in_reletion tomwells, buildin s, etc., can 6e laced on reverse side). FOR DEPARTMENT USE ONLY i � / s • ---------------------------- APPLICATION ACCEPTED BY.._,. ' ff ----------- ---------------------------------------- DATE--- REVIEWEDBYA----------------------------------- ------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------•------------------------------------------------•------------------------------------------- 'DATE------------------------------ ----------------------------- - N Alterations and/or recommendations:.------------------- ---------- - -------------------------•"-----------------------•-----------------------------------------------•------- ---------------•--- I; ------ I --------------------------------------------------- ------------ ---------------------------------------------- ------ --------------------- - ----- ------------------------ --------- ------- - -------- --r ----------- ----------------------------- ----------------- FINAL INSPECTION BY: .� !' / ....- Date----Z r�` ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT ` 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California F.P.O O.