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FOROFFICE USE: ---------------- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit Na. ---.. .. ..:.-----• + (Complete in Duplicate) �� ) __.._________________________________________________ ___ This Permit Expires 1 Year From Date Issued Date Issued ................... . Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. J This application is made in compliance.with County Ordinance No. 549. , JOB ADDRESS AND F LOCATIOtN_-v2-. --------------------- --------- ------- -•--•------------------•_-_-- . ------------•------•----•• ..........- -------.....------ •.Owner's Name------------ . f ----•-------------------------•-------------..----------•------ Phone.......------..... Address---------------- . -... - ------------ 7_2 - Contractor's Name--------- Phan e.............••..-. Installation will serve: Residence ❑—Apartment House ❑ ` Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I- Number of bedrooms _--3-- Number of baths __A._ Lot size 03: zod-�..............................:.. a Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table PP I y ,Gravel_❑. Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ � depth ❑ r of r Previous eApplicoat on Madeoff yes,date-and--___.-___) Noy New Construction: Yes ❑ .1 o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SFp c Distane from nearest well-----------------Distance from foundation--------------------Material---.-_-..--•--.--.-.-- ._..... No. of compartments--------•------ ------Size-------------_----•-- Liquid depth----•-•-------------------Capacity-----.7............... Dispos I 'e" . Distance from nearest well-f>V_-_ ..._.Distance from foundation... ......Distance to nearest lot line...s�'. ....... Number,of lines-----------------------------------Length of each`lin`e"_____. -Pf-_--- -_-_.Width of trench-----z y."..._•_---_-...______. Type of filter --_----.._-Depth of filter material.....�C--------.._Total length.......................................... Seepage Pit: Distance to nearest well--ln _-_---_-_Distance from foundation___! .__•__..___.Distance to nearest lot line- _-----._-.. Number of pits----- -`2------------Lining material--- -------Size: Diameter-.-.-- � ------Depth -• --�•--------, -----------•-- � Cesspool: Distance from nearest well................Distance from foundation-----'--------.._-.Lining material_--.----...._---___--_-_-.::.-..::-:,� ❑ Size: Diameter ., ----- Depth Liquid Capacity ry� gals. T V t Privy: Distance from nearest well-------------------------------------------_-.--Distance from nearest building.............................-------..--.. l ❑ Distance to nearest lot line -- ----------------------------------------...-._.--------•-------------------- - Remodeling and/or repairing (describe) y --------------------------------------------------------------------------------------------------------- 1V ------------------------------------------------------........--•---------------. . ......- /- -- . ------•----------•------- ------•--------• ................................•-------------------- r ---------------------------------------------------------------------------------------j_-__tib_. M 4.. ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and fegula+ions oft —San Joaquin Local Health District. : (Signed)-------------------------------------------------------------------------------- ------- -------------------- --------------------------------------------------(Owner and/or Contractor) By: ------------------------- {Title} (Plot plan. showing size of lot, location of sys em in r ation to wells, buildings, etc., can be placed on reverse side). FO ,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - lJ-= �� ✓_.- DATE--------- ------------ IZEVIEWI=D BY----- ----------------------�- - --- ------ - -- ------ ----------------'---- -- DATE ---•---------•-------- -- - BUILDING PERMIT ISSUED -------------•--------------------------------------------------'------------------------- DATE------..........----...... ---- --------- ............... Alterations and/or recommen ations:--."- � � �..-�.. " ��.. ,: �c. ......-.... f3 ------ Y / .....................................---------------------------------x...----•__.._......-_...-•--•----•---••-_••--•---•----------------------------------•-•--•--••--••-----•_-----_-----••---•_•-_•-_..........--•--•--•-- F t FINAL INSPECTION B / ..- ; -. Date ............ ► 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,Colifornla Tracy,California to 9 REVISED 8-54 9M 5-61 Att-A9