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OR OFFICE USE: A. �-- - --------------------- }7� APPLICATION F4R' SANITATION PERMIT Permit No. ------------- ----------------- ------- tJ f� m (Complete in Duplicate) ---- ------•" 1 -�-- -- -------- -------. Date Issued ---- --------=6x _---- ----------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construe and install the.work herein described. This application is made in compliance with County Ordinance No. 549. f $42f . JOB ADDRESS AND LOCATION -- ---- � .-. 41 - Owner's ------------------------- tj `�`��' _ Phone- _ Address<�� 1 _ .i_ / `�' �'""� ` Contractor's Name---- ---------------- �-� •------ � ` ••- Phone. _..__........ --•--------- ----------------------_- Phone,.o! will serve: 'Residence Apar me House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E❑ :'Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size ___-______________________________________________________ Water Supply: Public'system ❑ Community system ❑ Private �th to ter Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy 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: art 'ILL (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation--_.-----------------Materiai------:---------------------------- _-.______- ❑ No. of compartments----------- --------------Size------------=T--------------:-..Liquid depth------------ -------------Capacity----------------------- Disposal F' d: Distance from nearest well _r_Y-_Distance from foundation__/ -__Distance to nearest lot line--__/49.. Number of lines---------------------------/---Length of each line---------- _-- Width of trench__--_-• -------------- � -� -i of_filter.material--". -- aterial_ --Depth of filter material___--______ _Fatal length___.______ ---------------- Type. s Seepage Pit: Distance to nearest well_____________________Distance from foundation-------------------.Distance to nearest lot line----------------- 0 ❑ Number of pits---------------------Lining material----------------------.Size: Diameter-----------------------Depth____._.__.________---_- -----� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------------- _1 I El Size: Diameter------------------------------ -------Depth--------- ---------•------------- -- ---------------Liquid Capacity- --------------- --------gals.P Privy: .Distance from nearest well------ --------------------------------------Distance from nearest building------------------------._--------------- � ❑ Distance to nearest lot line------ -------------------------------------------------------------------------------I---------------------------------------------------- e t. Remodeling and/or repairing (describe)- - -------------°----------------------------------•-•--- ---------•-----------------------•-------------- ..-------------------------------•------ - • ----------- -- --------- --�------------- a --------------------------------------------------- wi .- ----------------------------=----------------------•-------------------------------------- ----•-- - -- ------- ( hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and regulations of the San Joaquin Local Health Distr' t. af�Lqc (Signed)___:,- '�'} 'L-� �--1 r Contractor) L BY;•------------------------------------------•---------------------- {Title) (Plot plan., showing. size of.lot, location of system in relation o wells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY # APPLICATION ACCEPTED BY_•- - 5---------- --- DATE--,'= .?= _ ------ ------------------ - - REVIEWED BY---------------------------------------<--- ------ -"DATE': ` BUILDINGPERMIT ISSUED---•---------=------------------------------------ :----------------------------- -------------------`0ATEM1Y4_2 ^:°------'A ------------ -------- -------------- Alterations and/or recommendations:--- ---------- --------- ------------------•------------- ------------•-'------- -_�:__---*---•--------------------------- --- ��b - ------------- --------- - ----------- ---------------------------------------------- -------------------------------•------- -----------------------Y------------------------------------------------ FINALINSPECTION BY:............. .... Date---------------------------- --- ------•----------------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Sheet .�, y.-, 124 Sycamore Street 205 West 9th Street Stockton,California f Lodi,California Manteca,California Tracy,California ES 9 RrVkSED 6-54 3M 3-'63 F.P.10.