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FOR OFFICE USE: �1 APPLICATION FOR SANITATION PERMIT Permit No. . Date Issued --- - -- -- -1--L- -(=-•- -�;-- [Complete in Duplicate} 1 ------------------- ----------- This.__- This Permit Expires 1 Year From Date 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 w' County QL&nance No. 549. .i JOB ADDRESS A ATION--- --- -1`' F Owner's Name______ --- Phone_,?.? "_�7,8"q ,,._. -------------_---------- Address ! ---ell,' ��'/� p Contractor's Name j- ---00 { Installation will serve: Residence [--Apartment House ❑ Commercial ❑ Trailer Court El Motel ❑ Other Eli - Number of living units: _/--- Number of bedrooms _---dumber of baths ---f_ Lot size ______________ ' r' ��- ----•-----•- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table %-"f+ Character of soil to a depth of 3 feet:4S and E] Gravel E] Sandy Loom ❑ Clay Loam L4 Clay F1Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_--------- ------) No [ New Construction: Yes ❑ No Q" FHA/VA: Yes ❑ No Er TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation------------------- Material--------------------------------------------____. ❑ No. of�compartments--------------------------Size----- ----------------------:---Liquid depth--- ---------------------Capacity---------------- Dispo� Field: Distance from nearest welL_�_ ._._Distance frog foundation____-/�-------Distance to nearest lone_- ________ L� Number of�lines___________�____ .._+_�►��-_length of�each line___ ".ate_..___ ry_ __.Width of trench_-.-,�_____�__________________ Type of filter material �,�__Depth of filter material---/AV-_ ------Total length-------Y-4q----_.____--�_�__. a Seepage Pit: Distance to nearest well"' _v®_-----_-Dista p fr foundation__f�__.______.Distance to nearest lot line__._-____.._ Number of pits------ Linin material__lt- 9e e_. Size: Diameter____ Q� p /----------- g / r. � Depth-' +� Cesspool: Distance from nearest well-----------------�Dis�nce from foundatlon...x_-_-_-.........Lining material---.__._..______---____.___________- ❑ �' -Li uid Capacity--. --_gals. re5.iie; Diameter. �" ---Depth r"" -,- 9 p Y Privy: Distan e from nearest we'll Y..______ - ------------------Distance from nearest building.__---_--________---_--_---._._.__-.-_. ❑ Distance to nearest loft line------------ --- ! /r ' G__�___ ^. k Remodeling and/or repairing (.describe��__-«�- _-: :___-_ � 1 i. ---------------------------•---------------- ----------------•-----{----�----- -----------------------------------•---------------- -------------------------------------- --------------------- ------------------------------------------------------------_------,---------------------------------------------- ------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws es and regulations.of-.the=San oaAqcal Health District. (Signed)------------------- ----- if '�`(' �-5 a ner nd/or Contractor Title (Plot plan, showing size ofilot, location of Sy in relation to wells, buildings, a#c., can be placed on reverse side]. 4s FOR DEPARTMENT USE ONLY may/ APPLICATION ACCEPTED BY- --• -- - '"`-•--•---------=----------------------- DATE----- REVIEWEDBY k DATE----- ----------------------------------------------------- G D---•- -------------------------- ---------- DATE------------------------------ ------------------------------ recompi ' Al#era#ions'and or '� �' BUILDING PERMIT ISSUE en�daItians:.____- ,- ._ - - s ----- ----------------------------------------------------------------------- ------------- - ----------------------- - ----------------------- ------ - - - ------ ------ ------- ------------------------ ------------- - ----------- q� 4 IL 6 FINAL INSPECTION BY: `tel Date----------- 1 f__---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.4laselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' Stockton,California Lodi, California Manteca,California Tracy,California F.P.CU. t -