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FOR OFFICE USE; -------------------_--------_4--------------------------- APPLICATION FOR 'SANITATION PERMIT Permit No.//,_ F-—-3 ------------------ ----------- =----------- --- -------- j (Complete in Duplicate) _____________ This Permit Expires 1 Year From Date Issued Dafe.lssued ______ I 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'w_ i_f_h County Ordinance-N 9: JOB ADDRESS AN LOCATIO ._ }____-� �- /1- r { Owner's Name_ _ _ _ ----------------- Phone------------------------------------ t• • -.�- Il �.+.-- Address `=_ ---- ------------•-.---- Contractor's�-Name = --------------------------------------------- ------------------------------------------ ------ Phone---•-----------------...... Instaliatiori will serve: Residence Apartment House E]- Commercial-❑ Trailer Court E] Motel ❑ Other Eli Number of living units: _____/Number of bedrooms___ Number of baths _!-___,Lot size �Q I �0-------------- l Water"Supply: Public;system ❑ Community system ❑ Private Depth to Water Table*.oft. Character of soil to a d pth:of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: 'llf yes,'dote.l=( ' '._._J No ❑ 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.) i SW Distance .from nearest well_________________Distance from foundation--------------------Material-------------------------------------------------- F No. of compartments-------------------- _-"Size--------------------------------Liquid depth---------------------- Capacity---------------------- A Id: Distance from nearest well-........ Distance from foundation--------------------Distance to nearest lot line_________.___.___ h"m Number of lines-----------------------------------Length of each line-----------------------------.Width of trench-----------------_-------_--------- � 3 SeepaM•Type.of filter material-________________________Depth,of,filter.material_---__________._______Total length-.-.-.-.--.--_____________________________ r. e Pit: Distance to nearest weII.�Q�_____:__Distanc fo dation__ _ _.___.Distance to nearest lot lin _________________ Number of pits__.--I--------------Lining material_ Size: Diameter.__ , _---------Depth_.`_a' -____________________ C sspool: Distance from nearest well---- -----------Distance from foundation--------------------Lining material__-.__.__---_____________.___-.____. Size: Diame er---: $------------------------------De,ofh----------------- ------------------ - ----- I.---._Liquid Capacity----------------------------gals. k "" ..._Distance from`nearest building Priv Distance:. Distance from nearest well---------------•---------------- --------- � g--------------------•--••----------------- ❑ Distance to nearest lot line------------- -------=•----------- ------------------------------------ •--------=-------------- --------------------------------------------- l Remodeling and/or repairing (describe)---------------------------------- = ------------------------------------•-----------------------------_... ------------------------•--•- ' =,- N w r i ------------------------------------------- •_- -------•-------------••-----•--------------•- ----------------•...... -----------------•---- hereb cert fy that-I'z-j------=--- i == --------------------------------r - = have prepared Mthis a plication and that the work will be done`,in accordance with San Joaquin County J ordinances, at laws, and xul and regtaiati of the San Joaquin Local Pealth District. r� F � �� ' -- -- ner and/or Contractor l (Signed} ----------- I By:----------------------------------------------- ------- (Title} i-..- (Plot plan, showing size of lot, location systemrinxelati to wells,,building , tc., can be placed on reverse side). C I+ #, FODEPARTMEN SE ONLY r --------------- DATE- v APPLICATION'ACCEPT .. Y- �r-�-- ,------ -- --- -- --�' - --:-- - - - - - _--�- --------- ---------- - -- REVIEWEDBYE"-----•------•-------z------- ------------ ----------------------- ---- ----------- ------ ------------ ------ DATE BUILDING PERMIT ISSUED---------------- ---- ---- - ': ____.DATE' /or recommendations:-- --- •---f--- ------------------------------------------------- ---------- ------------ ---------- -------- -- - ------ •--- --- --t � - - --- --------- -- -- ------ r 4 ----- - - ------- ------ ----- - --- ------ - -- --- -- - - ;. ✓` ------ -- ------ FINAL INSPECTION BY --------- _. _ .---- :_ - --- ---- Date_ --- ------ SANOAQUIN CAL HEALTH DIST T 1601 E.Hazelton Ave. 300.W stsOak Stree�' y,. 124 Sycamore Street 205 West 9th Street Lodi,California _ _ Manteca,California P Tracy,California Stockton,California „ ;• ES 9 REVISED B-59 3M 3••63 F.P.CD. "-