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FOR OFFICE USE: ------------- ------LDS ------------------------------ )_� .!?...---_-. APPLICATION FOR SANITATION PERMIT Permit No. .6��ee__6. ---------- ------------------------- --- --------------- (Complete in Duplicate) Date Issued --------------------------- This Permit Expires 1 Year From Data 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 is made in compliance with County Ordinance No..J549� JOB ADDRESS AN LOC TIO ®.vZ -------(.. ---------1./---�------------------------------------------------------------- ----------------------------- Owner's Name--- -- A -----•---------------------------------------------------------- --- -------------------- ------------------- -- Phone-.._.-------------------------.----- Add ress-------.-_---------- Xa ------------------------------------------•---------------------------------------- --------------- Q Contractor's Name------------- - ------------ Phone.'" ----- ----- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .. Number of living units: ,_ Number of bedrooms _ _ Number of baths ./... Lot size _...,5 '- /.do`.___--------------- Water Supply: Public system [L?-"Community system ❑ Private ❑ Depth to Water Table- -A ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--*Hardpan ❑ Previous Application Made: (If yes,date.-------.-_-_-----) No [��New Construction: Yes ❑ No ET-_'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) e Ta : Distance from nearest well_________________Distance from foundafion-------------------Material-.....-.___..____---------------------------.... No. of compartments---------------------_--Size--------------------------------Liquid depth- --------------------Capacity----------------------- D sa Id: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line------------------------------Width of trench---------------------------------- G Type of filter material----..............._....Depth of filter material.....-----.- --.......Total length------------------------------------- Seepage Pit: Distance to nearest well��l�/..Distan rom foundation,/�.-------jistanje to nearest lotLp' Number of pits-.-_._`.. ----------Lining materi ._.QGal. - - Size: Diameter-_ -3...........Depth--__.a. ................ Cesspool: Distance from nearest well-----------------Distance from foundation.----.--------------Lining material................----.._----.-----..... , ❑ Size: Diameter---------------- --- ---- -----------Depth----------------- ------------- --------------------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well ------------------------------------------.--Distance from nearest building--------------------------------.._------. y ❑ Distance to nearest lot line-------------------------------- ------------------------------------------------------------------------------------------------- ---------- 'r Remodelingand/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, St laws, nd rules d r ulations of the San Joaquin Local Health District. ---------------- ------------ -------------- --- -- ----------------------------- wrier and/or. Contractor (Signed)--------• ---------------- � � ) �Q (Tule}..� By:------------------------------------------------------ ---- --- ----------------------- ..----- (Plot plan, showing size of lot, location of system in relation to Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----=--- - '� DATE f ..` a REVIEWEDBY--------------------------------------------- ----- =- -------------=---- ------------------------------ DATE------------------------------------------ ----------------- BUILDING --------- - ----- ----- BUILDINGPERMIT ISSUED-------------------------------------------- ,------------------- ------ DATE----==---------+---------- ----------.-- --------------- Alterations and/or recom(nendatio :--__ .-. .___i�__�__:L..E?.,..._-_ �— .t'_`_--- ` -- - �__''�---•-- --------------------------- 61 ` � ------------------ -------------- ------- `-- ------ ----G --- -------- G v ---------------------------------------------------------------------------------------------------- ---- ------------------------------------------------------------------------------------------------------------------- - -------------- ----- ---------- --------------------------- ------------------------------------------------------- .Pvh h ` ` FINALINSPECTION BY:-..--- --- - - -- ------------------------------------------ Date----- ?:4--_6_-6------• ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodir California Manteca,California Tracy,California F.P.CO.