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'r FOR OFFICE USE: ------------------------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. -------- (Complete in Duplicate) Date Issued ------- _`_.. I�------- -- ---- - ---- -'-:"--`- __. 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 work herein described. This application is made in compliance with County Or inance . 549. ' � a JOB ADDRESS A CAT N ------ - - ----- - -------- •------` ----------------- - -- -------- --- f/ Own r's hone Address me - - -------- - ---- ------- ---- ------- ------C -------------- Contractor's •-----------Contractor's Name--- --- ----- '� �-f ------- - -•-•-----------, ---�� i ----�--- • ---- 9'_ -------1------•-- Phone.----/ Installation will serve: Residencpartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: _4IVumber of bedrooms _ tuber of baths _- t size ---_t/p, ....... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a idepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ s Previous Application Made: (If yes,dote___________ -------- No ❑ New Construction: Yes '❑ NoFHA/VA: Yes ❑ No ❑ �. TYPE.OF INSTALLATION AND SPECIFICATIONS: w ' No septic tank or cesspool permitted 4 public sewer is available within 200 fee+.}-.--- r- - - ••+x�---- Distance from nearest well-------------___'Distance from foundation--------------------Material _____.______________"_____________. No. of compartments---------------- ize-----_---------------- ._.Liquid depth. .........-..-----------Capacity------------` } � n�.,ry._s o ie d: Distance-fromrn'e6re,t well- _Q Distance from foundation__ Distance to nearest lot lin Number of lines=___ i` Length of each lin Width of trench 1 __ - !i7� 3_' _ Type,of_filte;material__,�p _Depth of filter material___-___ ___._Tota! length_______________:. __ -'____.____- 4 �ee�ag it y Distance to`nearest welL .QL.Cr--_bistanc from foundation___ - _.-..Distance to nearest lot line______- Number 6f-pits---l-------------- Lining material_ -- --------Size: Diameter---15�_/------Depth........ ' -_- --____:. Cesspool: Distance from nearest well_ __________.__Distance fro. foundation--------------------Lining material__-__________-________-__ ___"____ ; ❑ °', Size: DiamSeter----- '`- ` -----------_Dept h---------------------------- ---------------------Liquid Capacity--------------------------•gals: w, r f�:l �#r ti-r Privy: '" Distance from.nearest well ____"-___-________________ Distance from nearest building _______________________ ❑ Distance toearast lot line tt _ y.- �. �.._ .w._.w t .fit S L - Remodeling and/or'repairi des c 'beJ:,- --------------- -------------•------------ = r..�.. w „.,. -- - ---- -- - - /� � .. ______________ _ t ----------------------------------- -------.----- ----------- ------------------------- -- ----------------------- -------------------------.----------------------------------------------------------------- I hereby cerflf that I have'p a"pared this applicatio and that the work will be done in accordance with San Joaquin-Caun+y,. ordinances, State a s, a d rules and`regulations of the San Joaquin Local Health District. # .. -----------e- --- ---- -fl•-/S. -t----------------------------------------- onfractor. (Signed}----�------- ----- -- --------- ---��---- i- - I � 1 a By:--/----------- - ------------------------------ ------{Title}---------- --------- -------------- (PlotFplen showing siz oflocafion f5sy tem`' r ion to wells; b ildings;-etc.,`can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = +- ----------------------------------------- DATE-- " - -`-�--------------j---------- � REVIEWEDBY--------------------------------------------- ----------- - -- - ------------------------------------.--- DATE__” ...... -------------------------------------------- BUILDING ---•---------------------------------------- BUILDING PERMIT ISSUED--------------- c ---- --"------------•--- ------------- ------ DATE"-- -- r --- Alterations and/or recommendations 11-11 -------------- ------------------------------------ --------------•----------------------------------------.._._.----------------- - G •-------------- ----------------------- ------------------------------------------------------------------------------"-------------- rx ----------•--------------------------------- ------- ----------------- -------•-- ----------------- - -------------------------------------------•------------------------------------------ ----------- -------------------- J F€NAL INSPECTIOBY:-/-_ �_ ___ Date.... - ---- - - -- --- - --- --- --- --- -------------------------------- SAN J AQUIN CAL HEALTH DISTRWZI 1501 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California RE 9 REVi SED S-S9 3m 3--63 F.p.CD.