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FOR OFFICE USE: Permit No. ------------- --- --------------------------------------- APPLICATION FOR SANITATION PERMIT --------------------------------------:--- --------------- (Complete in Duplicate) Date Issued -----------I--------------------------- This Permit Expires I Year From Date issued Application.- -_is-_hereby. -. . -_m-acle-t-a.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. LOCATION�T 10 N --- --- -------- JOB ADDRESS Phone------------------------------------ Owner's Na ........ F3 - - ---------------------------------------11--------------------------------------- Address------- ----- ---------- ----------- -------- ---- ---------------------------------- Phone. Contractor's Name----- -------------- .... Installation will serve: Residence Apartment House 171 Commercial E] Trailer Court [:I Motel 0 Other [I Number of living units: --- Number of bedrooms-3---- Number of baths :��Lot size ----------------------------------- ------------------------ Private eDepfb to Wafer Table -------- ft. Water Supply. Public system Community system 171 Sandy Loam Z--Clay Loam C3 Clay [] Adobe C] Hardpan Character of soil-to a depth of 3 feet: Sand E] Gravel F-1 Yes E ❑ No Li Previous Application Made: (If yes,date------- ------------) No F1 New Construction-. Yes ❑ No Ej FHA/VA. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available,within.200 feet.) Materia�------ --------------------------- nclatio ------ Se nk: Distance from nearest well_ __0---- Distance from fou O'�0' i Zf"X!X_Liquid dep�h_---A4. ---------Cap V No. of compartments......7Z-��------------Size-/----- ------- 11 nearest well 0-"..-Distance from foundation------/-;?------ Distance to nearest lot line Dis field: Distance from ne --,!57k ------Length of -�/�----------------------- Pr Number of �ines----------3------- ----- each line......7A.................Width of french---2- Ir Type of filter material------ Depth of,filter material---- --------------Total' - ----------- - Type of filter material_____-t_ - p x � Seepage Pit: Distance ------- Distance to nearest well------------------- Distance from foundation-------------------Distance to nearest lot line-----. Seepage Pit: EJ Number of pits----------------------Lining .material-------- --------------Size: Diameter---------- ------------Depth--------- --------------------- from foundation------------- -- - - --- ------- Cesspool: Distance from nearest well______________ Distance -------Lin�ng materia - -------------- ----- --- l -------r--------------------gals. Size: Diameter----------------------------- - ------Depth--------- ---- --------------------------------------Liquid Capacity 0nearest well------------------------------- Distance from nearest building_____--._____._--_________--..---. ❑Privy: Distance from n ------------------- Distance to nearest lot line-------------- ------------------ -- ------- ------------------------- Remodeling and/or repairing tdescribe)------------------------------------------------------------------------------------------------- ----------------------------------------------------------I-------------------------------------------------------------------------- ------------------I------------------------------------------------------------------- -------------------------------------------------------- ---------------------------------------------------------- ----------------------- ------------------------------------------------------------------------------ ------------------------------------- -------------- --------------------------------------------------------------------------------- ----------------------------------------------------- -------------------- I herebythat I have prepared this application and that the work will be done in accordance with San Joaquin County c6rfft t rules and re Mations Health District. ordinances, State -w)�, and lations of the San Joaquin Local -------- and/or Contractor) (Signed)- ---------- (Plot plan. showing e of lot, I" ------(Title)----- ----------------------------------------- ........ By:_------ 0------------------- --- --------- ---------------------------------------- oCation of�4s �+em __ ii n lation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE------------&F-f 17---------------------------- -- ------ C ------------------ ------------------------------------ APPLICATION ACCEPTED BY-- --- DATE------------------------------ ----------------------------- REVIEWEDBY- --------------------------------- ---------------------------------------- -------------------- ----- ----------------- DATE--------------------------------------------- --------------- BUILDINGPERMIT ISSUED-------------- ---------------------------------------------------------------------- I------------I---------------------------- Alterations and/or recommendations:._._--_____.---------- - - -------------------- ---------------------------------------------------- --------------------------------- ------------------------------------------ ----- ----------------------------------------------- --------------- ------------ ----------------------------------- ----------------------- ----------------------------------------------------- ------------------------------------------------------------ --------------------- ---------- ------ -------------I------------------ --------------- ----------- ------------------- ---------------------- ----------- ----------------- ------------------I----- --- ----- -- ----------------- ------I-------------------------------------------- ----------------------- -------------------------------------- - ------------------------- ----------- -------------------------------- Date FINAL INSPECTION BY:. --- ..... .......... ----------------------------- --------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California California Manteca,California TTOCY,California F.F.C O.