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FOR OFFICE USE: --------------------------------------------------------- -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------- (Complete in Duplicate) --------------------�- � 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. --=..�_f�k'-� -_ _-�� -- - ----------- ------�-�--- ------ Owner's Name-- -,,�f __: .r1C ' r� ------------------------ ----- Phone ' F i f -t - - Address G}- � .. -G �a - -- --------------------- -- .......t--•...4- ... Contractor's Name---------- _ -� - ------ ------��-- ` t ------t'--U-- -JF- Phone Installation will serve: Residence Apartment House ❑ Co mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f ' Number of living units:'"/___ Number of bedrooms _ _____ Number aths _f_- Lot size .___ �____.__.'__-.-_____ Water Supply: Public system ❑ Community system ❑. Private Depth t ater Table -------- ft. sail to a depth of 3 feet: Sand Gravel Sand LoamCla Loam Clay Adobe Hardpan Characterof p ❑ ❑ y l-1 Y ❑ Y ❑ ❑ ❑ Previous Application Made: (If yes,date-------------------.} No ❑ New Construction: Yes 0 No ❑ FHA/VA: Yes D No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: y i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - t � Septic Tank. f Distance from nearest well_________________Distance from foundation_.__.- ------Material________=...____-:_:..___.._.________:____.-____. ❑ No. of compartments---------------------- ---Size------------- ------- ---Liquid depth------------- ------------Capacity-----!-------- ----- Dispose ield: Distance from nearest well� _._.._;Distance from foundation,____1_4_-------Distance to nearest lat�'line_:-��____:___-_ Number of lines_________ --- --- -- k.---Depth- Lenhoff filtehmlateria��.-�-9 `Total fiof len length nch=_��.-:'-------------•-- Type of filter material----- C / . 9 �5 .: page I Distance to nearest well __Distance from foundation_____ __p_.___.Diyanccfe t9 nearest lot-line____-�` __v.__ /� [1 Number of I "____f__ _-__--Lining material-------- -Sizer -ice._--Depth---- 7----------------------- �/ Cesspool: Distance from nearest well-_______________Distance from foundation_____.__.____.____.Lining material___._______.___.____..___________- 7 ❑ Size: Diameter----- -` ------------------Depth----------:-----3--- ------------------------ -Liquid Capacity ------------------------gals Privy: Distance from nearest well-___________________----__________--______.___._Distance from nearest;building------.__.-1____..__.-----------____-_-_ ❑ Distance to nearest lot line-------------------------- --------- ---------------------------- ------------------------------------------------- ---------•---------- 4 Remodeling and/or repairing (describe): --------------`----------------------•------•----------• -•------•--•-----------------------------•----------------- ----------------- ---- ----------- -------------- ---------------•-_•--=-------------------•-•------------------------------------------I--------------------:---------- --------------- -------------------------•-------------------------------------•--------------------------------------• ------ t I he certify that i have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws and rules and regulations of the San Joaquin Local Health District. ori d -- - ----- =-- ---- - ------- --- ----------------------•----------------------------------- dor Contractor (Signe- ; ` fi gY� ;= ` ' (Title)---------------------------------------- ................... r ! (Plot plan, sh g size of lot, locationf-sys em in re n to�wells,buildings, etc., can-be placed on reverse side). FOR DEPARTMENT USE ONLY _ A APPLICATION ACCEPTED..BY-- --- --- ------------ ------------------------ ------------ DATE---- ------- -------------- REVIEWED BY - `� ' - DATE----------------------------------------- -------------- BUILDING -------------------- - - BUILDING PERMIT ISSUED----------------------------------- "--- DATE € Alterations and/or recommendations: ¢ ---- ---------- . .1;- le i .E; l ------------------ --------------- - - -- ------------------- ---------- ----------'--------------------------------------•----------------- ------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------- ---- ---------------------------------------------------- ---- -------------- •�-a------ --'----------------------------------------------------- ---------------------- - ---------- ---------------- -------------------------------------- --------- ------ ------- ------ - ----------- ------------------------ --- ---------------------------------- FINAL INSPECTION BY: '.? ----------- Date-- - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxefton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Lodi,California Manteca,California Trac Stockton,California y,California ES 9 REVISED B-g 51 31H 3-•63 F.P.0 D. f S4 ,