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FOR OFFICE USE: ---------- - ------�-------------------------------- Permit No. _,.`.:-1 -----�'.S� APPLICATION FOR`SANITATION PERMIT - ----------------- (Complete`in Duplicate) Date.issued --------------------- --------------------_----___.--. This Permit Expires 1 Year From Date Issued C Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS LOCATION- - . -�------------ - -- `� e �- -- -- P tOwner's Name 'moi-'lZ ----•-- . --- --------- Phone --- ----- ------ ----•--- --- Address. t t � -- -•-•-------------------••----------•----•-------•--------- Name -"cam . ------ ----- -------------------- Contractor's - Phone.. ---•---- ' Installation will serve: Residence F1 Apartment House ❑ Commercial E] Trailer Court ❑ Motel 11 Other i Number of living units: ---'__ Number of bedrooms "_'Number of baths _? Lot size ---------------------------------------------------_-_-.y:_ Water Supply: Public system ❑ Community'system [I Private Depth t Water Table -_------ ft. Character of soil to a dep+h of 3 fe'e+:'#Send ElGrBvel C] Sandy loam-[Clay Loam ❑ Clay El Adobe E] Hardpan C]_ r__ o _ .. . . ._- _ . . Previous Application Made: (If'yes,date---------------- ---)"No Fl..R New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ _,TYPE.OF INSTALLATION AND.SPEC]FICATIONS:. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (h Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ....-;--_-!------------------------------------ ro ----_-- a acitY1171No. of compartments--------------------- Size :Liquid'deth" � e ----------------------- C jO Dispoeld: Distance from nearest we __Si?_/1--_Distance from foundation----IV__o........Distance to narest lot)ine------ -----•••- i' I Number of lines--- _-_---� Length of each line...--ASO-!=--_/�------Width of trema-�-------- ---------------- Type of filter material--------�- —-------Depth of filter material-------.� _.. Total length-------------------------------- ---------= Seepa e Fit: Distance to nearest wellI001_'1''--_Distance from foundation--_._� -____.---.Distance to nearest lot lines__--------- of pits--___---f___..- ----Lining material S.R-7--size: Diameter----Of- --------Depth--------------------------------- Number •s„_ Cesspool• Distance from nearest well-----------------Distance from foundation------- ----------Lining material--------------------------------------' Size: Diameter Depth---------------------------------_---------------- Liquid Capacity-- ------- :-------gals. .- _------_---_---_- ---Distance from nearest building-------------_-----__------__.--------._.;.5� Privy: Distance from nearest well----------------------- -------------------------------------- ! El Distance to nearest lot line----- ----------------------------'------------ I ------------------- Remodeling and/or re airin9 (describe): ---.------------------ --------•--------- --------------- --- am ------; - -------------- ------ - -------------------------------------------------------------------------- ---------------------------•----- ----------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws n rules and regulations of the San Joaquin Local Health District. (Signed) -------- -----_....- -------- torp - - 4. ` - ..: ... . ------� ------------ - --------- -- --- -. r By: . -- ------ --- - -- -- - -- - - --- - (Plot plan, showing size of lot, location of s stem in rola on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY r DATE---�°-- _ -J--e-7-------------------------- -- ------------ ------------------ - i: DATE----------------------------------------------------------- REVIEWEDBY-------------------------------------------- ---------=--------------_--------------------- ------------- ------------- --- -------- --------- ----. DATE---------------------------------------------- ------------- BUILDING PERMIT ISSUED----------------------- Alterations and/or recommendations------------------------- ! Date---------- •-------- -------------- -------------- ---- FINAL INSPECTION BY:----/_ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California