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FOR OFFICE USE: OS—If --- --------------------------------------------------- E Permit No. � - -- ------- ---{- .. , -__ --- --- ___---.-- APPLICATION FOR SANITATION PERMIT � / i t�\ ------------ _ (Complete in Duplicate) r -------------------------------- -------- ---- -------------------- --- This Permit Expires 1 Year From Date Issued Date Issued I 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 'AN LOCATION _.____r. n I Owner's Nam -• -------- -"�-�-------- :. ry -------- --- ----------------------------------- Phone------------------------------------ Address1_®•.-�. /'' °-- --------- ------- ------------------------- -------------•-----------------------------------------••------------------------------------ - C � Contractor's -----2 .... ---------- ------------------------------------ -----. Phone---------......-------••---------•- Installation will serve: Residence [f Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` ..... Number of baths _ Lot size _.__..7f' _ '�------------------------------------- Number of living units: __f--- Number of bedrooms Water Supply: Public system ❑ Community system ❑ Private Depth t9—water Table -------- ft. Y4 p Character of soil to a depth of 3 feet: -Sand ❑ Gravel ❑ `Sandy Loamff 'Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote--------------------1 No 0- 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.) _ r _ _ ,. .�I _ .. -_j. Septi ank: Distance from nearest —:ri- 'tion-_--_Distance from foundation__-/�__..-_.__.Material-- � ------ ---------------------- i No_ of compartments-------- _---_R�-----.-..-.Sized _ _X�,�__ Liquid depth__--------------------Capacity-/-�-a�''._ I DisField: Distance from nearest well----S_ r-_-Distance from found _/P ation- -------__---Distance to nearest lot line.--_-:-----_- poe Number of lines_---------.3------ ----,_Length of each line--_ee----.___.__-___._.Width of trench-_.�._-V-- ---------------._ Type of filter material---_------3%--- -'-----Depth of filter material _-0--~----.-----Total length---- r �y Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.......Distance to nearest lot line._----.---.-_-._- tom' ❑ Number of pits----------------------Lining material----------.-----------..Size: Diameter.----------------------Depth.------------------------------- P Cess ool: Distance from nearest well-----------------Distance from foundation _ __ .-.-----.-- _...Lining material--.-.------.-- ----.-_.--- 0►"V ❑ Size: Diameter----------------------------- -------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building. ---_----._---_-_--.-___-----. [J Distance to nearest loft line----------------------------- - --------•------------------------------------- ----------------- -- Remodelingand/or repairing (describe)---------- --------------------------- ---------•--------------------------------------------------------------------------------------------------------- 1 ---------------------------------------------------------------------------------------------------------•--------------------- --------------------------------------------------------------------------- - ---------------- r r --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- ----------------------------------------------•--------------------------•------------------------------------------------------------------------ I hereby c ' y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to ws, and rules and regulations of the San Joaquin Local Health District. er and/or Contractor) (Signed)----:-- ------------------ - --- ...... (Plot plan, s owing size of lot, location f syst in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_-_ - r� ? - DATE � ._ --! - - REVIEWEDBY----------------------------------------------- ----------:-------------------------------------------------------- DATE-------- ------ BUILDINGPERMIT ISSUED---------------------------------- ------------------- -------___---------------------------------- DATE-------------------------------------- ---------------------- Alterationsand/or recommendations-----------------=---------------------- ------------•------------------------------------------------------------------- -----•------------------------------- 1 --------------------------------------------------I-------------------------------------- ----------------- ------------------------------------------ -- ------------------------- - -------------------------------------------------------------------------------- '--------- .-----------------.--------------------------------------------------------------------...__--.---- -----------..-_._-"-• I FINAL INSPECTION BY� , ,-H Vis✓ ------- - ------------ Date-177Er ----------------------------------- ------------- I F 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.Co,