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�. l t -- ---------- ...___+__.____._ APPLICATION FOR 'SANITATION PERMIT Permit No. (Complete in Duplicate) . Com 1 Issued Lam_ %5�-_�� - ------ ----- -------------- ------------------ This Permit Expires-1 Year From Date Issued Date } 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. y t JOB ADDRESS AND LO ATION ca< l CS --------------- _- � = F Owner's Name____________ / - --:--- Phone------- Address c -e l Contractor's Name -r-----•--------------------------------- ------ ---- Phone.- Installation will serve: Resiclence�Apartment House 0 Commercial Trailer Court ❑ ❑ Motel ,❑ Other ❑ • Number of living units: :___/_ Number of bedrooms Number of baths __/._ Lot size ______�__//�_.f'{l _---_____________ r Water Supply: Public system j' Community system ❑ Private ❑ Depth to Water Table &?_ ft. Character of soil to a depth of 3 feet: 'Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam E] Clay ElAdobeo�/Hardpan 0 Previous Application Made: (If yes,date____________________) No 15'—New Construction: Yes ❑ No K FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f epfiic Tank: ,�jjistance from nearest wellDistance from foundation_..___�Q._.___.Materia}!___..__ of compartments._____._p7_ -_ ._ Size__ __ �J, Liquid depth d -----Capacity_ , I � Disposal Field: Distance from nearest well____. . N....Distance from foundation.___ _ - - � Distance to nearest lot line_- Is— Number of lines_------_________f__ .--,---,Length of each line------- 'D__._.�/ Width of trench.___ .. __------- ------ Type ---_ �} Type of filter material_ _ epth of filter material_-____--� _ rr -- -- -._Total length-------- -��---=---•------ -------•---- W 1 G Seepage Pit: Distance to nearest well .__��-__--_Distance fr m fou dation------/0_ ____.flisfianse to nearesfi lot line__._- __ Number of pits__.___�-.-_________Lining material x I'-Size: Diameter.___ _/._.. __Depth-'_...1-t.- �f//k'�__ r, "V Cesspool: Distance from nearest wel!_________________Distance from foundation---------__ ______.Lining material__-_._....___..____-____________--_. ❑ Size: Diameter---i----------------------------------Depth--------- ------------------ :-- Liquid Capacitygals. Privy; Distance from nearest weft___-------------------------------------------__Distance from nearest buildin ❑ Distance to nearest lot line--------------------------•-_.__--- - ------------ Remodeiing and/or repairing (descrlbe):__.�__._ __•-. _- . - --- -----•---------------------- J Xar ' ------------------------- - ------- - ----------------------------------------------------------------------------------- --------------------------------------- -- --------------------------------------------------------------- --------------------------------------------- - - - - - --------- ------------------------ - ----- - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, y1a and rules and regulations of the San Joaquin Local Health District. Signed - ---= -------- -- ------------------ -- (Owner and/ BY:---•-------------••----------------------- t - ----------------- -------------------- ------------------ --------------------------(Title)--------------- ----- ----------------- ...... ---- ..... -- E (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). J 1 ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-•------- ---- --- -- F-- ------------- DATE-----------f_-�' --� - t ------- ------- REVIEWED BY ---------- - DATE BUILDING PERMIT'ISSUED______________ ' - Alterations and/or recoDA•TE----------------------------------- ........................ mmendations:______________,-f___-_Li__/f'._ -----------------------1--- - ------------ - -------------------------------------------- �� -�� ' - - ------------------------------ ------------ ------------------------------;_= •---- i - - -- ------------ ---------------- �� ` FINAL INSPECTION 8Y:____... ___- — Date------------- '.� --- - - ------- ------------ ------ ----- it SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.C o. t