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T FOR OFFICE USE: `- ----------------- --------------`3 ` ° ---- --- Z-�G --------- . APPLICATION FOR SANITATION PERMIT Permit No. - :31... ___ ._.----_.__ .__- (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 iq all the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESSON ._ -a •�__ F_._ _ _._L________________ _______ ____ __ -- Owner's Name ------ - ----------------------------- Ph-o---n-e---- Address..-------�- - - - - ----------- -------------------- f----- -------------: — p ------- -------- - - ----- - ---------- ----------- Contractor's Name__. 1t.� r ` C�: t Phone kE Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel Other ❑ �. / / �} Number of living units: ___ __._ 6trnber of bedrooms --v-. Number of baths __l_._ Lot size ____._.7- ________X =---------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table Gaff. Character of soil to a depth' of 3 feet: Sand E] Gravel [ISandy Loam ElClay Loam E] Clay [I Adobega- ardpan ❑ Previous Application Mader(if yes,date-----------:_.._,_.} No ❑ New Construction:, Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: '°' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I S 6 1-2 Distance from nearest well-__.__.__._----_Distance from foundation_.-_______________Material.---_._____.__.--------_.._____.___--__..____- t f r No. of compartments--------------------------Size---------- ----------------Liquid depth-------------------------Capacity------------------- os Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_-________.._____ Number of lines--------------------- ---'-- ---Length of each line------------------------------Width of trench---------------------------------- Type ------------- ---- Type of filter material-____.______ .___Depth of filter material______________________Total length----------.__--______________.________-- .41 See a e Pit: Distance to nearest well40126E...___Distance from foundation_ _--- Distance to new of line--- __P_ ` } of its.--- -----_Linin material-Cp.Gk---- -Size: Diameter �_`__.___--Depth- j- -or---------------- Cesspool: Distance from nearest well----------------- from foundation- El Size: Diameter.---- ---- ---`---------------- ----Depth----------------------------------------------------Liquid Capacity- ------------------- Privy: -----------------Privy: Distance from nearest well-------------- ----------------------------------Distance from nearest building----------_--__._________----__..__-_.-. ❑ Distance to nearest lot line---------------------- ------------------------ --------------•-------- ------------------------------------------ -------------------------- Remodeling and/or repairing {describe]:------------- --- ------------ •-------------- -- -----•-------------------------- -- ---------=--------------------------------- - ffT ------------------------ --------------------------------------------------------------------------------- ----------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St aws, nd rules and regulations of the San Joaquin Local Health District. O dftwContractor(Signe ---- ----- -- C_ - .: F BY --------- - - ---- -(Title}----------------- -------------------------- -- -- �. (Plot plan, showing size of:lot, location of system in relation wells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_..-_..._._. ? � ---- -------- - -------- - ----- ------- ----- ---------- ------ DATE-- - --�-- --r--=- ------------------------ REVIEWEDBY--------------------'---- - ------------------------- - ---------------------------- ------ --------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------- _ ---- - - ---- DAT --- -------------- --------------------------------------- ` Alterations and/or recommendations------�1' ----- -- -- �� -•---------------------------------------------- - ------------•--•--------------------- ---------------------------------- ---------- ------------•----------•----------------------------------------- ---------------------------- FINAL INSPECTION BY Date-- --- ------Q_.- ---------------------------- , , 4 .---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Ca I iforn jar Manteca,California Tracy,California