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OR OFFICE USE: l ------------------- ! APPLICATION FOR SANITATION PERMIT Permit No. .. -.... :57 _-'M (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 permiWfnstrucf and install the work herein described. This application is made in compliance with County Ordinance No. 549. 1" -� 0.4 JOBADDRESS AND LOCATION - ------------•-------------'----------7_-----------------------------------------------------------------------•------------ I -4 '106 —S------------------------------------ Phone-_-------------------------------- Owner's Name---- ----- - ��- -�-"�--•----,-----�--/ - ^-� �• Address---------------•---......� ----------��/ e----------f -------------- ___ --------------•------------11-•----------•-•-----•- . � -� - Contractor's Name------.... -- - ------ ---------- ___ --.--- Phon _-_ -.-- ' - Installation will serve: Residence [EJ�Apartment House ❑ Commercial ❑� Trailer Court ❑ Motel C] Other El Number of living units: Number of bedrooms .__� Iumber of baths _/____ Lot size ------ --------------------- I Water Supply: Public system [l}�.ommunity system ❑ Frivate ❑ Depth to Water Table -------- ft. Character of soil to a depthl!of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Llay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: II(If yes,date--------------------) No [ slew Construction: Yes ❑ No 3---�F`HA/VA: Yes ❑ No E+--- I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation------------.------Material------------------ ------______-_.____._____.._. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth---------------- -------..Capacity----------------------- p llfrom nearest well--_ `..___Distance from foundation__ Distance to nearest lot line--�- ___ 10, bis osal field: Distance �o�- ----------- Number-'of lines----------- __.-..___._-_Length of each line----- f __-.Width of french.____r� � ............... Type of.;',filter, mafierial____%/t /> ___Depth of filter material--�A__ _..---_Total length_______ �.? ______________________ Seepag t: iu�abnecep to nearest wel"____ --— ---_Distance fro foundation_ _-_.Distance to nearest lot line_.:�Q'_- I` W + l`of pits.-------s/------- g p Linin material__ .__ _ Size: Diameter__.1 f�-__ _De fih____.�:. __�_________ Cesspool: Distance from nearest well_________________Distance from foundation.__.------_.__._...Lining material---------_- ___._..____.._-_______- ❑ Size: Diameter------------------------------ -- ----Depth----------------------------------------------------Liquid Capacity--------------------- ----gals. Privy: Distancep from nearest well- - ------------------------------------------Distance from nearest building------ --------------------- ---------- Distance.fo nearest lot line------.__ Remodeling and/or repairing (describe)= --:— / �, -----------1..... r _______-___. ______________________________I___---__--_--_ .---_____________-__----__-___--________-_-_.__--__._.-_-_-.__._____._-_________.___________-_-----_...-_.- Il _ ----------------------------------------------------- I ------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------- ----------------------------- I hereby`certif that 1 have prepared this application n at the work will be done in accordance with San Joaquin County ordinances, Stat aws, an ules and regulations of e n Joaquin Local Health District. (Sighed) / � - (O ner d/or Contractor) Title (Plot plan, showing size of lot, location of sy em in relation to wells, buildings, etc., can be placed on reverse side). k I! t j FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED!1 BY- --------- -------------------- -- --------------------- ----------------- DATE---- REVIEWEDBY-------------------- I------------------------------------ ------- - ------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-'F--------------- ------- -- ------ --------------:- L / _ DATE-------------- --------------------------------------------- Alterations and/or recomm ndations: T .�� ----- :. :gyp--------=Q--------- ------ ------------------------------I--------- ------- - -••------------- 11 �I ---------- ---------------------------------=--------------------------•-------------------------------------------------------•--- = -----------------------I---- ------------------'----------------------- - ----------------------------------------------------------------------------------------------- ---------------------------------------------------- II --------------------- ...... ..........G----------------- --------- -------------- ---- --------------------- ----------------------- -------------------------------------------------- FINAL INSPECTION BY k li ff Date-----------^_��_'�U. - - --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT k ! 1601 E.lfateltan Are.'' 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Cc llfornia II Lodi,California Manteca,California Tracy,California F.P.CO.