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FOR OFFICE USE: .= Permit No. -- _. ? APPLICATION' FOR SANITATION PERMIT ----------- -- ------------- ----------------------------------------- (Complete in Duplicate] Date issued _ ......�-=-4,7 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 insta4l the work herein described, This application is made in compliance with County Ordinance No. S49. JOB DDRESS AND OCATION-- - -------- -------------- ------------------------------------------------- Owner's Name---- a r ` - --------------------- Phone._ -Z--` �a-Z`S� 3 - ' ---------------- --------------------------------- ----------- - ----------•------------ --------------- --- .._.... Address-----------------------•-------- - ---- h00, ---------------- _4! 'Contractor's Name ---t - ---_- -- •----------- Installation will serve: Residence Apartment House 171 Commercial ❑ Trailer Court E] Motel [I Other ❑ Number of living units: Number of bedrooms Number of baths Lot size -----• - a -------- ` Water Supply: Public system ❑ Community"system ❑ Private Depth to Water Table-S.-4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (if yes,date-------------------1 No F1New Construction: Yes ElNo [p" FHA/VA: Yes E] No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l pt' Tank: Distance from nearest well-------------____Distance from foundation-------------------Material-------------------------------------- ---------• �l +� No. of compartments--------------------------Size---------------- Liquid depth-------------------------Capacity----------------------- isp I rField- Distance from nearest well-----------------Distance from foundation----- --------Distance to nearest lot line_______--____-___ rt Number of lines------------------------- -Length of each line------------------------------Width of trench--------------.--------------------- 1 Type of filter material-------------------------Depth of filter material-----------------------Total length----------------------------------- ( f �-1 Seepage Pit: Distance to nearest well./o°__--__- Distance from foundation__�_�---_.-___Dista(ce to nearest lot linef ___.-_ Number-of. pits---- f_------- ---Lining mate ria lV�_ -----Size: Diameter - -------------Depth----- - ------------------- Cesspool: Distance from nearest wall_ ______________Distance from foundation._.._.--------------Lining materia .-.--------------------------- al-- s. ❑ Size: Diameter------------------------- -------:--D"epth------------------ ---------------------------------..Liquid Capacity- --------------------------9 Privy: Distance frominearest well----------------------------------- -------------Distance from nearest building---------------- ------ ❑ -------------------------------------- Distance to nearest lot line-------- ------------ -------- -----------•------------- --------------- ----- Remodeling and/or repairing (describe):------- -----------------=---------- ---------------------------------------------------------•-------------------------------------------------------- -------------- ----------------- ------------------------------ -------------- •-- ----A --------------- --------- ---------- -- ------------------------ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules anjd regulations of the San Joaquin Local Health District. r and/or Contractor) --------- - ----- Title)--- - ----- --- - - Y:----------------------------------------1----------------- (Plot plan, showing size of,lot, location of system- - in re-l-ati- -- -- on to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -- DATE--- - (--�' 'l-�I-------- --- ----------------- - - -- - REVIEWED BY------ ------F--------------------- -------------- D ATE-------------------------------------'---------------------- BUILDING PERMIT;ISSUED-------------------------------- DATE------ --------------------------'---------- -------- Alterations and/or recommendations:-------.--------------- ------ -f--•------ ------------ -----`- ---------------------------------- - ------------------------------- ------------------- ------------------------------------------------------------------- ------------------------- --------------- -------- ------ Q.- ----------- - - --------------- - ---------------------------------- - -------------------------------------- . - ------------------- ----------r . Date ` FINAL INSPECTION BY:.... ..........a........ --------- 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 ' F.P.C o.