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FOR OFFICE USE: y 17.�r � -- - - �f APPLICATION FOR SANITATION PERMIT Permit No. _ .... . i ------ ------------ ------ ---��1---------- --------3-�-�©- a _ (Complete in Duplicate)- -�. �' Date Issued --------------------------------------------I-------._._ . This Permit Expires 1 Year From Date Issued t Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. t This application is made in compliance with County Ordinance No. 54.9. n JOB'ADDRESS AND LOCATI ----+ --�-------- ` -----------------•-------- Owner's Name ••-' ---- - -------------------- - - Phone Address--------- JLf ....10 Contractor's Name......... - --•---P---------------- ---•----•------------=-------- •-------------------- Phone----------------------------------- r ;4 Installation will serve: ResidenceApartment House ❑ Commercial [j Trailer Court .❑ Motel ❑ Other E],f I Number of living units: _/___ Number,of bedrooms _�. Number of baths _,/__ Lot size..J� P*_/,�______-_____________________ Water. Supply: Public system .Community systems [I Private ❑ Depth to Water Table 4�f_ft. Character of soil to adepth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe ®hardpan E] Previous Application Made: (If yes,date_------,-----------) No PP/'New Construction: Yes ®moo ❑ FHA/VA: Yes ❑ No (ate TYPE OF INSTALLATION AND SPECIFICATIONS:- Septic Tank: Distance from nearest if public sewer is available within 200 feet.) [No septic tank or cesspool per p rest well____'_.-_Distance from foundation______/�_____.Mate ial _ t ,e7i Size Liquid de th ' � Ca tacit �� No. of com artments_____ ___________. � p _ � �------- q p. ---- ---�-------------- P Y-•�--------------- Disposal Field: l Distance from nearest well-------------Distance from foundation---f ---------Distance to nearest lot line_J._-_.__._.. [ Number of line's_____n_. ____.._ Length of each line____'_______y_._.Width of trench.--__________ ___ Type of filter.matenal- DlDepth of filter material_,- ___-_._-Total length-__9 __-_ Seepage it: ( Distance to nearest well------__-_ ------Distancefr m fo ndation__-_/:0_-_____.Distance to nearest lot line_��------ [ ( Number of pits_---1_f-________Lining material---A04A---Size: Diameter___ r ------_-_.-_ , Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------.---------------- J ❑ Size: Diameter------- ------------------------------Depth---- -- -------------- ----------------------------Liquid Capacity----------------------------gals. Privy: f. Distance-from nearest well-----------------------------------------------Distance from nearest building----------------_-------------=---------- I ❑ ------------------- Distance to nearest lot line._ = Remodeling ah d/or repaiPing(de-scribe,: --- '- l _ ._I � ----- --------------------------------- hereb certify that I have prt;pa------------•------=--------------------------•-------------------_-------- ordinances, ce laws, and rules and red this;application and that the wor`,k will be done in accordance with San Joaquin County i regulations of the�San-Joaquin-Local-Health-District. °I (Signed)-------- ------------------- --- ------------ -- ---- --- --------------------' --------------------------[Oweer-a�f or Contractor} ' BY: --- .. -- --- [Title}.- /1 . (Plot plan, showinyg site-of_lot, locatiori'of syste relation.to wells, buildings, etc., can be placed on reverse side). . i FOR DEPARTMENT USE ONLY APPLICATION�ACCEPTED BY------f/L: - ''DATE •ri 1' ---- REVIEWED BY---------•------------ -- r ------------------ DATE------ BUILDING PERMIT ISSUED---------------------'r-------------=--------- DATE----- -•----------------- ----- --------•------ Alterations and/or recommendtio ans:-.��-} . __ - —------------------------------------.1. � � X71 .. - " -- --- ----- -- --------=------------------------------------------------------------------- -------------------------------------- j,. ------------------------- ---------- ------ - ----------------------------------------------------------------- -------------- - -- ----------------------------- -------------------------------------------------- T FINAL INSPECTION BY: �= C1/ Date--->�- /7/�� ----------------- �` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave• 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED B-59 3M 3-'63 F.P.Cr7.