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FOR OFFICE USE: --------- ,� - �- APPLICATION FOR SANITATION PERMIT Permit -No. ------------ - ------------------------------------------ (Complete in Duplicate) i Date Issued --- ------------------------- --------------------------- ... 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 install the work herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION---- � �f7, 1 -------------- -------------------------------- g Owner's Name--------- 71 ��r .�J.l.l-!/ Phone • - L- Address-------------------------------- t ------- ------------ --------------------------------------•------------•------- Contractor's Name - -b'�` K. r# _ r Phone__ C � Installation will serve: Residence; Apartment House ❑ Commercial E] Trailer Court F] Motel ❑ Other El Number of livingunits: � Number of baths _� 1.____ Number of bedrooms -____ Lot size __________ Water Supply: Public system ommunify system E] Private F] `—Depth to Water Table ��'ft: k 'Character of soil to a depth of 3 feet: Sana` ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe Hardpan Ell Previous Application Made: Ilf yes,date____________________) No F] New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ i It TYPE OF-INSTALLATION AND SPECIFICATIONS: (No se tic tank or cesspool permitted if public sewer is available within 200 feet.) epti Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- f�. No. ofcompartments - Size T Liquid depth---------------- ----- ---Capacity------ ---------------- po �eI Distance from nearest well6-0-tLe._Distance from foundation___._ 4f-----Distance to nearest lot lines_f_____ Number'_f lines___:____,---- '______.___i___. _ Length of each ach Iine _ __�------------ Width of french___c r. 4 Type of.filter material a _ ... epth of filter material-----------------------Total length_____________________________________-- -Is3--____.Distance to nearest lot line_.._ it:� istance to �earey�t well__ __Dist m undation_____ _ C Number of pits___.)_..__- Lini g mat rial_ ____ Size: Diameter� ��. p , j De Cher -._ Cesspool: Distance from nearest well-_-j----_------bis m oundation--------------------Lining material____.._________________._________.__.� ❑ Size: Diameter-:------------------- --------.Depth------- - ---------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well --------------------------------- --------------Distance from nearest building_._._.___.______._.__.__________:'...___--- ❑ Distance to nearest lot line__.___'___.__ 4 � E rr Remodeling and/or repairing (describe:- f --------- - --- ------------------- ----- - , ------------------------------------------------- --- •--------------------- - --- - - -- - -- --- --- -- ----------------------- ----------------------------------- l I hereby certify that I have prepared this applicationand that the work will be done in accordance with.San Joaquin-County ordinances, State laws, a d rules and regulations of the San Joaquin Local Health District. R (Signed)- c .ar_:'✓t 1'and or Contractor) By:-------------------------------------------•---------------------------------- --- ----- (Title)-- ------------------------------------------------------------ (Plot plan, showing size of lot, location of system in relation to ells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ 1 --- .-.�'✓�-- -- -------------------------- DATE-------.T --- - --1�'3�___ -.---------- REVIEWEDBY-------------------------- r ----------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------ - ------------- --------- DATE-------------------------------------------------------- --- Alterations and/or recommendations:_-__,7 ��` ._. _� - 5' - --------------------------------------------------•---•--------------------------- v ------------- -------•------------ •-----------------------•------------------------------------ -------- ---------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.- / C� ._ Date.... 3` ------ ----- - --------------------------- 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 I F.P.QU. v I