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FOR OFFIC USE: - APPLICATION FOR SANITATION PERMIT Permit No. ......... ....... r>'F � a�'�s I _ (Complete in Duplicate) ----- -- --- Date issued ------------------------------ ---- ----------- ----------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construe# and install the work herein described. This application is made in compliance with County'Ordinance No. 549. p - -----------------------•-------•-------•-------• -----------------•------------ JOB ADDRESS AND LO TIO7.0, ------- r----- --------- 16 Owner's Name-------------- ------------------------- Phone...... 74_� ------ ---lam? "' ------------------------------------•--------------------------------------....---- Address------•--------------- -------- �,. 1 = ---- , Phone -------- -- -----••-----Con#rector's Name Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I___ Number of bedrooms I--- Number of baths __.___.iLot size _ x Y Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ t}• j 2 '7 6�f ' � Clay Adobe Hardpan ❑ Character of soil to a depth of.3 feet: ..Sand ❑ "Gravel ❑ Sandy Loam ❑ Clay Loam ❑ y ❑ ❑ Previous Application Made: (If yes,date..........-----------) No [L-"New Construction: Yes'.0 No ®--FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer-is available within 200,fee#.1A ► , F Septic Tank: Distance from nearest well_---_- '--__`Distance from foundation____l�_____Mat�ial_____��'� l Size Y 11__Li Liquid de #h_-- _-- .. Ca acit �-C�---- I No. of compartments q P� �' �' Y•- V :r { r / l Disposal Field: Distance from nearest well-___________------Distance from foundation__ ,1�-----,..Distance to nearest lot !i�--�_�.____ Number of lines________-------_ 'Length of each line------i. ------------! W clth of french____,X.V ________________ IQ ep �-'_- ta'l length----.... -------------- Pit: Distance to nearest well--____________-_-- _Distance from foundation_________________;.Dt V" Type of filter material. o1D th of filter material _ To Seepage Pi a _ istance to nearest lot line_________________ � ❑ Number of pits-------=--------------Lining material-----------------------Size: Diameter- _------------ -------.Depth-=-------•------•------•-•------- Cesspool Distance from nearest well_-___________._'Distance from foundation--------------______Lining material---=______'t.-_______-__________-_____ ❑ Depth ---------•------- -Liquid Capacity--;------------------------gals. Size: Diameter--------------------------------- P Priv Distance from nearest well______________________------------------------•Distance from nearest building.___!_!'___-____________..--- Y . Q : ------- ❑ Distance to nearest lot lii�e_I__._..-- �= --------------------------- ---------- I ��/� � _.- - - , i } ------------------- Remodelingand/or repairing describe -----------------•----------------------'-------------------------------- f i' ----------------- ------- I hereby certify that I have prepared th.rs-application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a d rules and regulations.of the San Joaquin Local Health District. ' j-------------------- (Owner r Contractor) (Signed)_ 1 ` `_--(Title)--- '? ( p { g y ells, buildings, efc., can;be placed on reverse side). • Plot, Ian, showin size of.lot, location of s 5t m in relation fo w FOR EPARTM)NT_USE-ONUY APPLICATION ACCEPTED BY •- --- -- -----= ------------------=--------------------- DATE ='+ -` .=r":�n:-Q----------------- REVIEWED BY------------------------ - - -------------- DATE :_: BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- DATE - I; Alterations and/or recommendations:--- y ------•-•-•--•-••------•------ ------------------------------- ------------------------------------------------- -------------------------- ---------------"= ----------------------' •-------- ---------------- ------ -- - -- --------------•--------------------------------------•----•------•--•---- ---------- —� ---------------------------- ._. .. ------------------------ r FINAL INSPECTION BY: ..---- Date__. 0 0 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Ook'5treetst 124 Sycamore Street' 205 West 91h Street , .� �;� ti � �� Stockton,California Lodi,California fJinnteaa,Caiifornid Tracy,California f'.� E8.9 REVIB6P B•69 F.P.0 6�¢M 6.6P