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FOR OFFICE USE: 3 U ` /7 APPLICATION~'FOR SANITATION PERMIT Permit No. ;-- ------------------------------------- ---------------- (Complete in Duplicate) Date Issued -�-�-- This Permit Expires l 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. R - --- JOB ADDRESS AND LOC O ------------------------------------- --------- _ - ' Phone ...Owner's Name---27: - ---- ----- � - ------------ -----Address_...- T ne-------- ------••-----_---•-•---- Contractors Name-- ----------- 7= ------------I----------------------------------------------------- I---------------- Installation -- ---- ------ --- ---- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.--/--- Number of bedrooms,__Number of baths _1.__ Lot size __�¢ ---+ �----------- -- Water Supply: Publicsystem [t ommunity system ❑ Private ❑ Depth to Water Table 40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {lf yes,date____________________a No New Construction: 'Yeso FHA/VA: Yes El No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi T nk: (� Distance from nearest wel#-----------------Distance from foundation_____- _____-_--_-_.Material_________------___-_---__.______-----_.-_-_____. No. of compartments--------------------------Size---------------------------------Liquid depth--- ----------------Capacity-----------•---------- Disposal eld: Distance from nearest welirf_______Distance from foundation---14�----------.Distance to nearestkt line_f,-�_.___--____ �! Number of lines7_/'-------------------=--------Length of each line------1--------4 ---------.Width of tronch--- ------------------ N Type of filter mater: I-e t ._____-Depth of filter material-_je-__ ________Total length---------- P------------------------ _____________Distance from foundation__* _1_________.Distance to nearest let iine_.�--------- Seepage Pit: Distance to nearest well--" Number ofpits-- /-----------------Loring material--- __. Depth ' -3 � 31 Cesspool: .�- Distance from nearest well-----------------Distance from�oundation-----' Lining material---.._______._.__.------- ___-______. J+' --Size: Diameter-_. ❑ Size: Diameter--------------------------------------Depth--------- - ---------------- -- ------------------Liquid Capacity---------------:------------gals. rG Privy: Distance from nearest well________________________+.--__----.-.-----------Distance from nearest building.---.---__.-_____.__________°i__-.- r ❑ Distance to nearest lot line-- --- ----------------------- ----------------•---•---•---------------------------------------- ----------------r Remodeling and/or repairing (describe)=---------------------- --------- --------------------------------------------------------------•-•-------------•-------------------- ------------------ ------------•------------•------------•----------------•---------------------------- ----------------- •- ------ ---------------------------- •-- - -- ---------------------------- -------=----------------•--------------- _ - ------------- --------------------------------- I hereby certify that I have aRd 'red th appli tion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules regal ions o he San Joaquin Local Health District. (Signed) _ .__-.(Owner and/or Contract or) = $ _.__. By:--- ------ ----------- --- --------- - -- ----- ---------------------------------i - --------------------------- ----------------- ----- -(Title] ---- -------- ----- ----------- (Plot plan, showing si , locatt m.of system ' relation to wells, buildings, etc., can.be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ��--------_.. ._ -..-C2� -� ----------•---- ----- DATE-------/ �> REVIEWEDBY-------------=----------- ------ ------------------------- ---------- ----- DATE----------------------------------- -------------------- rl� eISSUED�,.ING PERMIT - ------------------- DATE-------/- -------'------------------------ - ------ ommendations: � 1-.- -------- Alterations and/or rec � t t ----------------------------- •-- ----,------------------- --------------------------------------------•---------- --------•-•----------••--------------•---- 1 0 --- -------------------------------------------- ------------------------------•----------------------- ----- ---------- - -r - T . --- 4 r� - FINAL /INSPECTION BY:.,_'` Date-------e. - ------ > -- ---- err t.,. .r i SAN JOAQUIN LOCAL HEALTH DISTRICT 1 t 300 West Oak Street_ 6Street -. 205 West 9th Street tig7,601�ETdHaielln.Ave. r kv. 124 Sycamore- " ' E, .Stockton,CaliforniaLodi,California Manteca,California Tracy,California S - tREVICiED 8-59,3M,3-'63 F�P_C�d y.�„yq.