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i FOR OFFICE USE: J Permit No. .. l�J`5 r ------------ APPLICATION FOR SANITATION PERMIT - w _ (Complete in Duplicate} Date Issued . -------------------- _y_(4_ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the Iwork herein described. This application is made in compliance with Count Ordin ce No. 49. JOB ADDRESS AND LOCATION_ .-U__ ____ - - ------------ Phone--------------------------------------------- ----------------------------------- ------- ' t----- Phone Owner's Name--- -------- ---------------- --- -- ---�--=--=--.�.," --- ---------- ---------- ----------------------------------------------------- Address----------------- -------------- ---•----------------------•-- ---------- Phone----------------------------------- Contractor's Nam - - --------S__2 = - Ii Other E]Installation will serve: Residence [Apartment House El Commercial E] Trailer Court C] Motel ❑ Number of living units: _/---- Number of bedrooms CZ-- Number of baths /------ Lot size --c - -f'r •- - Water•Supply: Public system 13___(ommunity� system [I Private C] Depth to Water Table o ft. Character of soil to a depth of 3 feet: Sand C1Gravel [I Sand Loam [I Clay Loam [3 Clay E] Adobeiardpan ❑ Previous Application Made: (If yes,date----- -- ........ No New Construction: Yes �No E] FHA/VA: Yes ❑ No t � TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: ? '--Distance from nearest well------------_....Distance from foundation_ ------------------Material------------------ ---------- --•----------------- Li uid de #h-------------- - Capacity-------------------- i ❑ o. of compartments-------------------- ---Size-------------------------------- Distance ---------------------------- -Distance from nearest well-, ---Distance from foundationl_�- --__ _._.._.Distance to nearest lot lin ---------------- Disposal _ -�--- Disposal Fiel Number of lines ------------ ---Length of each line----.?A--- -------------.Width of trench_- �---el--------------- ___._ ----------- - Depth of filter materi.al_/ ----- --------Total length Type of filfer material._- k- / See pa Pit: Distance to nearest well____- --------Distan fouation__F_p_____________D' tanc�r to nearest lot 00 __( _______ Number of pits____/. L ____ -_ - r.-- r --- Depth Lining material__ Size: Diameter 6 i Cesspool: Distance from nearest well__________ ___Distance from foundation---------- -___.._..Lining material--------------------------------- aIs. r ❑ Size: Diameter----------- --------------------------Depth---------------------------------- -----------------Liquid Capacity----------------------------9 Privy: Distance from nearest well------------------------ --------.. Distance from nearest building---------------- l ---------- ❑ Distance to nearest lot line------ ------------------------------------------- ------------ Remodeling and/or repairing (describe):----------------------� --------- ----------•----••---- -- -------------------------- ---------------------------------------------------- ---------------------------- --------------------------- - 5 ------------------------------------------------------------------------------- ---------------------------------------------------•------------------------------------------ --------------------------------------------------------- I hereby certify that I ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an r es regulation f San J quin Local Health District. + _ ---- .. --------�-----------------------------` =---------------------- '(Owner and/or Contract (Signed)__-- d/o or --- --- # Title ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,"can be placed on reverse side). FOR DEPARTMENT USE ONLY I + DATE------------------- APPLICATIONT� ACCEPTED BY------------------ --_.___.-.- -_ = ---_DATE-------------------•---------------------------------------- REVIEWEDfa- BY-------------------------- ------------------------ ----------------------------- ---- ----------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------ - w Alterations and/or recommendations:__: -___ ------------- ---------------- -------------------- �i - - - -- - -------------------------•------- ----------------------------- ---------------- ------- - --- ---- ----------- - Date------------- FINAL INSPECTION BY-------------------- -- - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 16ol E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,CalfFornla Lodi,California Manteca,California Tracy,California r