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t: -- ------------- ��° O ------------------------------------ 3 D---------- APPLICATION FOR_.SANITATION PERMIT Permit No. 5 --------- ------------- ----- 2_ � _ _ ____ _____ (Complete in Duplicate) -- This Permit Ex fres i Year From Date Issued - Date Issued ��S 6 � 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 -` " LO TI 4 ,05 6e Owner's Name ,[� a ----------------------------------------------- -------------------------- ------------•--•-----•------•-------------------- Address •-------------- ----- �--C_k_e.co__ Phone-- ---------- XApartmenf -----------Contractor's Name---- ---- -----•-----------_ --- -----. Phone--.--- Installation will serve: Residence - " ---"--- -"House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: I--- Number of bedrooms - �,( ❑ Other [] Number of baths _f--_ Lot size a/ �� Water Supply: Public system Communit system / -- ------------ Y Y ❑ Private ❑ Depth to Water Tabled_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Saricly Loam ❑ Clay Loam ❑ Cla Previous Application Made: (It yes,date-__.__---____-_- ,_..,� Y El Adobe dpan ❑ "-) No Ly I�ew Construction; Yes !o ❑ FHA/VA; Yes ❑ No 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--� [!� No. of compartments ---- .Material------"_Y - "'�+•' ----------------- p ................. ---- ------ -- Size-_3_. C-s ----Liquid depth------�_/" Capacity-Disposal F�Id: Distance from nearest well-.. _._Distance from foundation-__--- _ __ -- Ca acit I -�_ Distance to nearest l t knee---- Number it lines---------- -------- Length of each Dine_--_- _-.o ___ Type - - Width of trench . yp of filter materia-__- lZ c.b Depth of filter material- _--- Seepag it: Distance to nearest well - Total length--- d_i------ p ----,Distance fr fou dation--- -Q_--(_Distance to nearesf dot Jing s Number of pits_--_-_-/ ---------- material- p� / J -G- ---Size: Diameter.•�_.�_��-- ---Depth- El Depth- -----5----------- Cess ool; ____ P Distance from nearest well_--_---___-"__-_Distance from foundation_-- -_ - _-"__.Lining material------------------------------------- Privy: ----- --__ ❑ Size; Diameter---------------------- --------------Depth------------------ - - -- ----------- ---------------------Liquid Capacity--.------------------------ Privy: Distance from nearest well................! _ � gals. _ _--- --__--Distance from nearest building-------------"______- ❑ Distance to nearest lof line:-_ `_`_____________ ---------------------- ------ ----------------------------------------- ------------------- emodeling and/or repairing (describe):-------- --------------------------------------------- - .'"" _ ------ � -- - - -1 IT -------------------------------------------------- --------------------------------- I hereby certify that J have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State) ws nd r, les n re lations of the San Joaquin Local Health District. (Signed)----•----- - ` r Owner and/or Contractor --- ----------------------------------------------------------(Tin-relation ..--------- tle)----- Plot plan, showing si f Jot, location o system t relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- _ ; _ REVIEWED BY e(I---"---------------------- ----- ------- ---------------- ----- DATE_- " 5 -- - ------ ----------- ------- BUILDING PERMIT ISSUED----------- - -"------------------ --- -- ----- -------- ---------- ------------------------ ---- ------- - ------ ----------------- DATE-- ----------------- Alterations Aaerations and/or recommendations:---------- - DATE -------------- -- - - ---------------- --------- --------------------------- ------------------------------------------------------ d - ---------- - -- ------I-------- --------- -------------- -- FINAL INSPECTION BY; a-_ % -------------- __ ------ --rO-�---------- ------- Date - ----------------------------------------- SAN JOAQUIN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California 205 West 9th Street F.P.CO. Manteca,California Tracy,California