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` FOR OFFICE USE: "� l � t ------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. __t -�_`� ...... ---------------i---------4--------------- =---------- .-AComplete in D pricate} - � ,�.�_-'_-�-------- `� ------------------------------------.-.------- his Permit Ex Tres 1 Year From Date Issued Date- Application is'hereby made to the Sap Joaquin Local Health District..for a permit to construct and install the work herein described. This application is made il) compliance with County Ordinance No. X49: t {p JOB ADDRESS AND LOCATION_-- -- -- a I I J a� , ------------------------------------------------------------------------------------------ Owner's ------------------- --- --•--- : . .� . -. � p s Owner's Name • - Phone ------------------------------------ Address------- --�`-- �----- Contractar s,Name =�1----------------- --------------'-•= Phone Installation will serve: Residence'ki' Apa+ment House '7Commerc4al ❑'. Trailer Court E] Motel L] Other E]Number of living units: _/---,Number of bedrooms S_ Number of baths -�-.,,Lot size - _„�(- � Water,Zupply: Public-fsysfem P. Community system ZP�larivate ❑ Depth to Water Table CF✓ t� ., w Cheer of soil +o,a depth of 3 feet: Sand [] GravelE].. $andy Loam [-] Clay Loam El Clay E] Adobe �ardpan E]Previous Applic ion l ad {I ye"s;da#e`-_- .-.. ) No New Construction: Yes Flo ❑ FHA/VA: Yes ??-"No ❑ TYPE OF INSTA°LL'--ATIO�N AND SPECIFICATIONS: (No septic.tarikr,,cessool permitted if public sewer s.available.within 200 feet.} t.. IWOx Septic Tank% ; Di�,ten�e� nom nearest ---well-.---- _- Dist.a-nce- ,frSffoun..d-ation-- � . .�e: of compartme ' :ic`id'cepth ---- ----Ca acit Disposal Field: Distance from near st well -"...-Distance from foundation-_A�-------Distance t6 nearest totline_ Len thof each line _ _______ Number of lines-- g� ,�-- .-_Width of trench.---------------- i �` 'Type.•of filter.material_,t� G'C epth of.flter,material- - p. f- Total length ----------------- See en th- See a e f+t;: sfance fo -nearest well- A---- Distance fr rrm fou dafion —" 12 9 --- , --- .Distance to'nearest lot lined----- -. -Number of pits__ .rA---.--I----Lining material" �/ -Size: Diameter .---Deptn Cesspool:w ' Distance from nearest we'll------------------Distance from foundation - -.' g _--.._----..Linin material-------------------------------------- 6 Size: Diameter ---- 'k Depth. j-__: Liquid Capacity - gals. 0 ------- ---- �e Privy: Distance from nearest well': � ;_-__----- - -- --Distance=fram•nearest.build ..v.. in9-- "I,_❑ Distance to nearest lot line!--_.-------------------- - ' --------•-------------------- -- = - ------ Remodeling and/or repairing (desc ribe�: ---�i�� --- - -- -- -- -- e ------`---- p - --------- ---------------._- .. t _ _1 ----------- ----••-----------------------------------•-----------------------_-•- -•----------------------------• 1 I y�. - . ------------------------------------------------- :_ = ---- -----' I hereby certify that I have prepared fhis••application-arid that the work will be done in accordance with San Joaquin'County. R ordinances, State,laws, and rules and regulations of the San Joaquin Local Health District. - f (Signed) r - - Contractarj - - -- - -- ---------- � , �' - {Title}-- - --- ------- - - - ----- ----------------- --- - Sy:-----------------•••------------------------- -- (Plot plan, showing size of lot, locati f system-in.relation to wells, buildings,•etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ----------------- APPLICATION ACCEPTED BY-------- ;---------- - '`-= DATE � = REVIEWEDBY------------------------------------------"--- -------- ------------------------------------------------ DATE-------------------- ----------- BUILDING and/or recommendations:---}--(-:.-X-q----� UI DIN PERMIT ISSUED--------------------------------------------------------- ------ A - ------------- ------ -r . z ---------------- ---------------------------- r a R jj -C FINAL INSPECTION BY:. f za->LT Date. ------ - R -- --- � i SAN,JOAQUIN :LOCAL HEALTH DISTRICT ` `9 \.l \ A- 1601 E.Hazelton Ave. 300 West,Aak 5lreet. _ y 124 Syca re Street 205 West 4th Street F Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 {,p•p A:•