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FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT Permit No. ----------------- - ------------- 0 ---_-__----- _f , (Complete in Duplicate) g g 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-�_L_--^--------------------or--------------------------------- - . ------------- --- ---------- - --- -8 Owner's Name-- /_l.f ------ Phone------------------------------------ 3Address- / 1-3----- �p Contractor's Name-- Installation ame - - --•--- Phone.�W----� . 'z u Installation will serve: Resionce Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f! Number of bedrooms __r__ Number of baths __`_ Lot size ---_-400f�__ - _ . ______ ________.__ Water Supply Publid system ❑ ;,,Community system ❑ Private Depth to Water Table la- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date/.q6.Q.-_7-) No ❑ New Construction: Yes ❑ No X FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septictankvor cesspool peimittedri#-public sewer is available-within-200 fee}+;�- .� pt• Tank: Distance from nearest well_________________Distance from foundation..-.._______-_-___.Material-------_-_--_-.._.__-_-..__.___-_---.___-___-- No. of compartments-------.----------------- Size--------------------------------Liquid depth----- --------- ---------Capacity...--- --- -- Disposal Field: Distance from nearest well ®_-------Distance from foundation.3_4_........Distance to nearest lot line_-��._._._.._ YP lines Z----------- Length of each line--1/410----ro--- .Width of french------a-y___ ____________� T Number of filter material___��__%l�� Depth of filter material__—.--..----_Total length---- - Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material----------------------Size: Diameter----- --------Depth--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material....----------------------_----..._._ ❑ Size: Diameter---------------------- --------------Depth----------------------------------------- ---------Liquid Capacity-.-.------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----:-____._____--------___-----..____._. ❑ Distance to nearest lot line---------- ----------------------- ---------------------------------------------------•------- --------------------------------------------- Remodelingand/or repairing (describe)------- -----------=-------------------------------------------------------- -------------------- -----------------------------------------------------•-- ------------------------------------------------------- I I 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 an regulations of th San Joaquin Local Health District. (Signed) ---------- - Owner and/or Contractor �. -. - ��- _.. _ --------- ---------- - - Plot Ian, showing size of lot, Iona —-------- ----- --- -- (Title)-- -- ( p tion of system in rel f n to wells, buildings, etc., can lie pla`cFd FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.--. J0 - ----------- - ---- DATE----f��-z�'�p `�------------------- REVIEWED BY----- ---------------------------------------- - ----------------- ---------- - ---------------------___------------------. DATE------------------------------------------------------ BUILDWG PERMIT ISSUED --------------------------------------------------------------------- ----- DATE Alterationsand/or recommendations:----------------------------------- -- ------ ------------------------------------------------------ -•----------------- ---------•-------------------•------- t r --•------------- ------------------------ ---------- -------•--------------------- --------------•------------------------------------•------------------------•- --------------------I------------L------------]------a-----�.-------------- t - ------ ---- - - --------------------•------------- ----------------------------------------------- - ---- --------------- FINAL INSPECTI2 Z 105 - Date_ -c -- SAN JOAQUIN LOCAL HEALTH DISTRICT r 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.