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FOR OFFICE USE: " OR SANITA'T'ION PERMIT Permit No. . 1-�-�- -------------------- APPLICATION F ____� ___- (Complete in Duplicate) 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____ �- "... Owner's Namer•1 � ------------ - Phone Address----- ------- //_. ._� < .� '�--< ------------ Contractor's Installation will serve: Residence Apartment House 171Commercial F] Trailer Court [I Motel [I Other C] � - -- Number of living units: _. - Number of bedrooms _ - Number of baths :._ Lot size ------- ------------------------------- _ Water Supply: Public system Al Community system ❑ -private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dpte_ ------- ----------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION-AND SPpCIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------- Material ---------------------- ❑l�t'l No. of compartments--._ -------- ----------Size-------------------------------Liquid dep.th-----"--- - Capacity - Disposal Field:- Distance from nearest well--_-_-_.—__Distance from foundation;_-._ S-j. Distance to nearest lot line__,_42_/... Number of lines.__________.__. . Length of each line---------- �..�:Width of trench...... '----------------- - Depth of filter material_ _ `�_ __-Total length____.___ ----------------- ►>T Type of filte,�ma#eriai__-- --_-_--- P -- - -- '` Distance�o nearest lot lin _ --- Seepage Pit: Distance to nearest well____..---__-____Distance fro foundation______ ____________ Number of pits_:..____________Lining material.:_. Size: Diameter--- "---- Dept h___-- ----------------- --------------- Cesspool• Distance from-nearest well-----------------Distance from foundation__--------------- Lining Capacity gals. ❑ Size: Diameter. __. -------------- ---------------Depth...---------"-- --- ---------------------------- q P y----------------------- Privy: ------------ Distance from nearest well___-__----__-_-__ ___-_--------------------Distance from nearest building-_---__-_-__.-___-___.__------_.__. r ❑ Distance to nearest lot line --- --' ----------------------------------------------------------- ---- --------`- --- ----- - i — Remodeling an /or repairing ( scribe .___- t/Ot,� rz- �"`� , --------- c �"�° r? '._. r_'"� �� ---------------------------- ----------------------------------- ___ ------- ----------------------------- ------------------------------------------ -- -- ---------------------- - - 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, and rul and regulations of the San Joaquin Local Health District. Owner and or Contractor] (Signed)--------= �"- < --f-,oma =------ -------------------------------- --------( / (Title)--------- ------- ------- ----- By:-------------- (Plot plan, showing-size of lot, cation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY E APPLICATION ACCEPTED BY------------- `-- ----- -------------------------- DAT � '��/i� REVIEWED BY------------------------------------------------------------------------- ----------------------------------------------- DATE-------------------------------------------------- BUILDING PERMIT ISSUED--------------_------ - ------------------------------ DATE.. '� s � L`---�---------------------------------------- - Alterations and/or recommendations:__..__f��_f----------------------- ----------------- FINAL INSPECTION BY- - Date ----- ------- 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.CC.