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FOR OFFICE USE: ; .� ------------ ________ __________ ___�4.{� APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------------- / p lin Duplicate) Date Issued This Permit Expires ires 1 Year From Date Issued Application is hereby made,tgg Ve San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made,,k co pliance with County Ordinance 549. JOB ADDRESS AND LOCATION_ C.>'C' , Owner's Name -------•- --- --------------- ------------------------------- Phone n Address-------- r� Contractor's Name---------- ---- --- - --------------------------------------------------------------------------•-----._. Phonxl�/_ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/ Number of bedrooms -.2 iumber of baths ---I--- Lot size ---------------------------------- Water Supply: Public system ❑ Community system ❑ Private INt Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe k Hardpan ❑ Previous Application Made: (If yes,date........... ........1 N?,gr 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.) Sep ,.: Distance from nearest well------------ --_Distance from foundation--------------------Material----------- __ - X10. of compartments--------------------------Size------ ----------------------Liquid depth---------------------- Capacity------- --- _-.--____--. ------- Disposal Field: Distance from nearest well__G._`.-Distance from foundation__/D--r______-Distance to nearest lot line__it_._�_____ i , (g Number of lines-_______/_______________________Length of each line___.,('-- ------------Width of trench. ..!P-9 Type of filter materialo6g.C-of--------Depth df filter material__ IY__!---____Total length---- _ a Pit Distance to nearest well &0_ Distant from foundation___.� .�- Distance to nearest lot line--- ` '� 4 --Size: Diameter. Depth Cess ool: , D'istance from nearest well_________________Distance from foundation.____-.-______-.._..Lining e al _ Hum er o its___________ ____ _ Linin material_ �_ XID-- p ------------------------------ ❑ Size: Diameter Depth- -)--------------------------- ----------------Liquid Capacity-- - ----------------------gals. Privy: Distance from nearest well------__ - from nearest building,,-------- _________________-.------- ❑ Distance to nearest lot Jine---------------------- ------ ----------------------------------------------------------------- I � I Remodelingand/or repairing (describe)---------- ----------------------- ----- -----------------------------------------------------------------------------------------------------------------r f ------------- ----------------------------------------------•--------------------------------- ----------- - - ------ / - -------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- --------------------------------------------------------- - -----------•--------------------------------- ----------------------------•-----------------------•---------------------------------------•---------------- --------------------------------------------------------------------------------------- ------------•--------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joal'quin Local Health District. (Signed) --------- ------------------------------------- --------------a------ Title......-� ---------------------------------------------------------(Owner and/or Contractor)ll Plot Ian, showingstem size of lot, location of s in rela}ion to� r _I - y ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____-.- s ` -------- ---` DATE --------------------- ---------- ,t ----- - ------------- REVIEWED BY ------------------------- - -------------- ------------------ DATE-------------------------- BUILDING PERMIT ISSUED__.... --------- I DATE f Alterations and/or recom end ons:__-._ -. Lw4 _ _ ------------- - ------ 47�- _eel k 19-------- � -------------- ------ ------- ---------- ------- -------- -------------------r------------------------- ---- ---------------------------- ------------------------------------ - --------------• --------------------------- t 1 FINAL INSPECTION BY:--- ..c_ Date - -------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Haselton Ave. 300 West Oak Street 'i 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California i Manteca,California Tracy,California F.P.C 0. I