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Imo„ FOR OFFICE USE: ,l A - -------- - Permit No. _.. .---- . APPLICATION FOR SANITATION PERMIT ------------ f, ------------ ----- (Complete in Duplicate) -------- --- ---- --- --- - P Date Issued ... �. - --------- ------------------- - This Permit Expires 1 Year From Date Issued Applica#ion 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 Ordingince No. 49. ,. /4 ��_ .------- ---"�� -1 LOCATION.-__�i-/ JOB ADDRESS AND ---=- -; Owner's Name-------------- Y -- -- ---•--••----------------------------- Address --•------------------------ _. Ph ne Address--------- •--------- -----• --- Contractor's Name____________ _____ _ - - - - -------------- 1_ Phone.----_--------------------------- ' Commercial Trailer cour t _--Mtel Other ❑ Installation will serve: Residence Apartment House ❑ ❑ ---- e - - ---� ----•• -•---------------•-----•-- Number of living units: __1--Number of bedrooms-- Number of baths �i j Water Supply: Public sys#ems[] Commuriity system Private ❑ Depth-to Water Tab = Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p�C1ay ❑ ❑ Previous Application Made: (if yes,date----_._ ..__--__--) No � New Construction: Yes 2- No ❑. FHA/VA: Yes g3 [:1 TYPE OF INSTALLATION AND SPECIFICATIONS: } (No septic tank,or cesspool permitted if public sewer is availablewithin200 feet.) s T k: Distance from nearest well----_1�----- Distance from foundatio ----_.:___.MateJj___4r-- - ----* Septic No'. of compartmenfs-----,�----------------5ize- from found Liquid depth--.-, -------------Capacity-- -dam •-•---- each line__ ' w Disposal ld: Distance from nearest well._._r__.._.Distance � ation-__��-� Distance to nearest lot �e_ ______ _____ Number of lines__- ----- ---------:Length of e j ✓__ Width of #rench_-_ ,--•---------- De th of filter material—Adr- ----•-.Total length.---o9_ ®_-•-------------------•-- Type of filter material _ P -.. Seepage Pit: Distance fo,nearest well____-________________Distance from foundation____..__._..___.___.Distance to nearest lot -ne____.____-_-___.. ❑ Number of pits----------------------Lining. material..------------------Size: Diameter--------- ------------ Depth C Cesspool: Distance from nearest well-______________•:Distance from foundation...__._- ----.____.Lining material____-______.___________..___.__.als. �` Size: Diameter------- -----------------------------Depth--------------------••----- ---Liquid Capacity------- 9 ❑ ----Distance from nearest building �. . Priv Distance from nearesfi well - - -------•----------••------•------•----- y: .. _ _ rtr . - ❑ Distance to nearest.lot line----------------------------------------------------------------------- ------•-------------------- ---------•----------------=--------- Remodeling and/or repairing describe :__.____-_ - 2 -------------------------------------- __ _-------- _ __---- _--- _____----------__---- ___ __--- __ ____ --- _--- ______----- ___.____-__.____..____---__------- ----- _--_.--------------------------- __.._____._.._ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and regulations of the.San;Joaquin Local Health District. - ---------- ------------------------------(E h!B2ngMdA5r tractor) (Signed)_________________.__-_____--___--____- By:-------------------------------------------------------- ------------------- -----(Title)---�✓' r ---------------- -- -------- (Plot plan, showing size of lot, location of system in r on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY , 4 .: APPLICATION ACCEPTED BY--- 1 -r--( '0Z------------------------------------------ DATE .."DATE---------------------------------------•---------------- , --------------------------- REVIEWEDBY---------------------------- ------- ------------ -------------------- BUILDING PERMIT ISSUED------------------------- ---•---------------------------- -------- DATE------------------------------ ----------------------------- -- Alterations and/or recommendations:-_._-_____- -------------------------------------•-------------- ---------- ----- ----------------------- , - �`• -----•- --------------------------•------•------------------•------• -•---------••------•-•--------------- . .------- FINAL INSPECTION BY:-_ - -•---- Date__. ± /-- -^' -`----------------------------- •! Y SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California Ce-9 PrV19C0 B•99 r.P.1i0-9M 6.60 -