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F OFFICE USE: A '} - M1 ______.._-.___________________________________----_--- APPLICATION FOR SANITATION PERMIT Permit No. ..,/ 7 (Complete in Duplicate) ----------- �° -------------------------- m Date issued Date Issued This Permit Expires I Year From Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. --- JOB ADDRESS AND LOCATION_ L -- -- Owner's Name t �' �.___-----f - - Phone 7 3% ,C Address - ----------------------------------------- ------------ ----------- Contractor's Name------------------- v= ----- •-- -"-------------- Phone...... ✓/ Installation will serve: Residence Er--Apartment House ❑ Commercial ❑ Trailer Court '[:] Motel ❑ Other ❑ Number of living units: __/._ Number of bedrooms _a,'- Number of baths ----"/_ Lot size ------- .......... Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table-574� ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑" Clay ❑ Adobe B-_H' ardpan ❑ Previous Application Made: (If yes,date--------- ----------) No ❑ New Construction: Yes ❑ No B-- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �1211_ is Tank: Distance from nearest well______________Distance from foundation------------------- Material------------------------------------------------- 2.t ______.__.________-_._ . ----------------------- No. of compartments-------------------------Size--------------------------------Liquid depth---------- --------------Capacity---•--------- � , is osa Field: Distance from nearest well�4�stance from foundation---./D- ._.Distance to nearest lot line__�..- _____; Number of lines-------l--------------- Length of each line___ U__._. _.-___.. ,Width of trench____._ -,x�.___.__._.______-� . Typd-•of`filter materialSr. /� _Depth of filter material--- ---------Total length_---- --________________________ i. Seepage Pit: 2 i Distance to nearest well----------------------Distance from foundation---------_-________Distance to nearest lot iine----------------- ---- , Number of its______________________Linin material_____.._.__..._ ❑ _ _ P g -------Size: Diameter----•�---------------- Depth- ------------------ Cesspool: -- ----------- r Cesspool: e :.:Distance from nearest well_._ '_-_-_::.._'Distancfom'foudaton-._ ..-___" Lining material_ ... ------------------------------ .410 e _..------- __. . 01) El Size: Diameter_._7__._`. ------ ------ Depth -- - - --- ..Li uid Capacity ------------------- ----gals aF Privy: � K* :,Distance from nearest well-------------------------------.--------------...Distance from nearest building-------------------------------.-----____. ` ❑ Distance to nearest lot line...... 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 ordinances, Stafell4ws, and rules and regulations of the San Joaquin'Local Health District. (Signed) ---- •----------------------------- �- - ------ (Owner and/or Contractor) B --------------------- -- ----- -------------------------------- - - -- -- --- ----------- -- - -- -- -- --- ----- - --------- Y t --- ------------- ----- -- {Title)-- (Plot plan, showing size of lot, location of system i elation to wefts, buildings, etc., can be placed o reverse everse side). FOR DEPARTMENT.USE ONLY APPLICATION ACCEPTED BY =- ------------------- v- -- �� DATE REVIEWED BY--------------------------------- ----------- ------ DATE BUILDING PERMIT ISSUED-------------- -------------------------------------------------------------------------------------- DAZE Alterations and/or recommendations--- ------------------- - ------- ------------------------ -------------------------------------------------------------------------------- ----------------- ----------------------------- ---------- ------------•-------- -------------- ------------------------ -----------------•------.-...------------------------------------- - - ---------------------------- FINAL INSPECTION li __lLx� -- J--------------------- Dater-- -- - ---`- --------. 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 Tracy,California F.P.00.