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_� _ 7 3 , 3 T ------- G ---------------------- --------- _ --- APPLICATION FOR SANITATI ON PERMIT Permit No. __, ��0 -- ---- --------- (Complete in Duplicate) i ----_.•-- -- --- ---- ---- ----------- --- - -- �--� "-""-`- ---- -- This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit t - -Date Issued ---�'--- S— This application is made in compliance with County Ordinance No. 549, C2 / p o construct and install the work herein described, JOB ADDRESS AND LO ATION._:_o2-f /�/ ` Owner's Name_ l r - ------•----------------- ._--- Address______.__. �y, �. - --------- --- -- Phone --------------- ---------------• Contractor's Name----- t • Installation will serve: Residence • --------------------------------------�---- Phone_.---•------------- ��Apartment House �- -•---------__-.- Number of living units: -__a✓-- Number of bedrooms❑ Commercial ❑ Trailer Court ❑ Motel ❑' ❑ Other ❑ Water Supply: Number of baths _P2- ��D 17 PPIY= Public system � �� ---- Lot size ��.� L "Communit system •"------ - ----- __._____ Y Y Private .._�--------------------- Character of soil to a depth of 3 feet: Sand ❑ Depth to Water Table ft. ❑ Gravel ❑ Sandy Loam Clay Loam❑' Cla Previous Application Made: (If yes,date-__.- No Y ❑ Adobe _ �a•rdpan ❑ TYPE OF INSTALLATION AND SPECiF1CA.... K "� ' New Construction: Yes ❑ No Q�FHA/VA: Yes 4'rA O (No septic tank or cesspool permitted if•public-se er is�available within 200 feet.y v_ ept• Tank: Distance from nearest well--------I--------Distance from foundation________-"- a. of compartments__- ---_ Size-,------------- �� --- -.Material-------------------------- ----------�'---------------- Number I el Distance from nearest-well_._- Liquid depth---- ------ ----- -----Capacity .--_-__Distance from foundation_.�Q.-,---- Distance to nearest lot line__ '--� " Number of lines - ---------Length of each line_7 Type of filter materia)___.f C�QC-A-- Depth of filter mater f Width id f hle of n See Pit h ------------------- -A p Distance to nearest welL._-..~- Distance om foundation-AQ-_- Number of pits--- ----------------Lining materia----/ , Di tante to nearest lot line Cess ool: _C14(-Size: Diameter-___- ` Cesspool: Distance from nearest well-----------------Distance from foundation-_-__---- Lining material- _- -_- ----- ---.Depth__.--w� t Size: Diameter__-_. _-" - ---- - - - - ---Depth---- Privy: ----- ---- -------Liquid Capacity------------- Distance from nearest welt-___-._-_---"._- I ❑ gals. C - -- ----------- --------"-.._-_Distance from. nearest building Distance to nearest lot line_-_-__.__-_-__.-_ ------------------------------- -- ------ -emodeling and/or repairing (describe)-------------- --- ' ------------------------------------------- ------------ __.._._- ---- 'x'� - f ___- --------------- ----------------------------------------------- - ___"----------------------------•- --------------------------•--•------------___-__-___ _-_---•------_ ____"_ -------------'--- -------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordant ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. e with San Joaquin County (Signed)----------------- - gY� (Owner and/or Contractor) o (Plot plan, showing size of lot,.loca#ion of system in relation fo walls, buildings, etc., can be placed on revers -- ----------- ---------------------------------(Title)----------------- e side). -- -- FOR DEPARTMENT USE ONLY PLICATION ACCEPTED BY .-- ......------- -------- !----------- _----------------- ---- DATE._ REVIEWED BY..- -- _ -- ---- _ BUILDING PERMIT ISSUED----- ------------- ------------------------ --------------- -- DATE_ ..................................... , Alterations and/or recommendations:._..__. -�� DATE_-.__------ ---- - - ---- - = ---------------------------------- ------------------------------- ------------------ -------.------------------------------- --------------- .----------- � - - -- -- --------------------------------------- --- ------ - INAL INSPECTION BY:.-_-_----�: - - -----------"--- - -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Ma:eltort Avg. - . k 300 West Oak Street Stockton,California T24 Sycamore Street Lodi, California 205 West 9th Street i Manteca,California F•P•ao Tracy,California