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-------- K FFICE USE: �PPLICATION ---- - ------- --... � FOR SANITATION PERMIT Permit No. --------------------------------------------- (Complete in Duplicate) T `` .....-------------------------_.__-----_.------__----.-. This Permit Expires 1 Year From Date Issued Date Issued ____��.�__.k �3 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 A LOCATION... __.......... . ._.y_9---. _------------------------------------- PhoneOwner' m ------------ .1 ' - f .- r .................. Address t - •-- ----- -- - ---------------� ----- ----- --- -•---------------•----------•----• Contractors Name........ -------- ---- o Phone... Installation will serve: Residence f Apartmen House C] Commercial E] Trailer Court F] Motel ❑ Other [INumber of living units: __.L-._ Number of bedrooms _-_ Number of baths ---1... Lot size __``__.o�------- ------------ ------------- Water Supply: Public system F] Community system /Private ❑ Dept o Water Table 46 ft. Character of soil to a depth of 3 feet: Sand❑ Gravel 171Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (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.) Septic Tank: Distance from nearest well.................Distance from foundation.-._.-_•_-__-..-----Material-------------------------------------.-.-.--._.-. ❑ No. of compartments------------------f----.Size................--------------Liquid depth------- ----------------.Capacity-- ----•--S--------- Dispo I Field: Distance from nearest well. • _---. ._Distance from foundation....eQr Distance to nearest lot ane_________________ Number of lines............7........... .. Length of each line------- _. --------Width of trench Wiz,._____ �R ---Total length - - t ------------------ Type of filter material-_,/�._.Depth of filter material......,�X! 9 � .................. See pa Pit: Distance to nearest well. -,�.i�ft-_-.._._Distance from f undation-._____,�_Q. -_.Distance to nearest lot line.-._�____._ Number of pits-----�--_--_.--Lining material--/I4 .Size: Diameter----- Depth Cesspool: Distance from nearest well-----------------Distance from foundation..------------------Lining material-.-_-_....._--..-.._-..--._--__-._. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity---------------------------- 9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_--..-..___---.---___._______.......__.._. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------•----------------------- Remodeling ------------- Remodelingand/or repairing (describe):--------------------------------------------------------•---------------------•--•------------------•--------••------------------------------•-------•--- --••--•-------•---------------------------------------------•-------------------------------------------•----....-----•-•-------------------•----•--------------------------------------------------------------------------- ---------•--------------•-•---------------------------------------------------•---- ----------------------------------•---------------------------------------------------------------- ----•---• ------------- ------------------------------------------•---•---------•----------------------•----------------------------------------------------------------------------------------------------------------------------•---------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules nd regulations of the San Joaquin Local Health District. v/ ^ a (Signed)......... `�C �% -•• !'`� ."' or Contractor) By� -- --------- ol........ -`�`------- �------------------------------------------------ . - - - - -- ----(Title)--------- - - (Plot plan, showing size of lot, location of syste i?fS n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -----------------------------•----------------------- DATE-----1 X04..----•---- ------- REVIEWEDBY------ --------------------------------------..--------------------------------.............................................. DATE-----------------•----------------•----------------------- BUILDINGPERMIT ISSUED...........----•----------------------------------------------------•. .............................. DATE----...----------- ------------------------------------------ Alterations and/or recommendations-------------- -----------------------------------------------------------------------------•---------•-------•---------------------------------------- ........•----------------------------------------------------------------------------------------------------------------------------------•----------------•-•-•----------------------------------------------------------- ---- ------------------- ---------------------------------------------------------------------------------•-------------------------------------------------------------•------------------------------------------------ ............. -•-----•-••------------ -----•--•--------- -------------•-------...---••-------------•-------------------------------------- ---------------------------------.................................. ---------------------------------------- ------------------------------ ------------------------------------------------------ ------------------------------------------------------- ------------------------------------- FINAL INSPECTION BY: ' , --------------- Date �' ----------- ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3M 3-°63 F.P.DO.