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FOR OFFICE USE:; 'S --= ---------"-------------------- �» APPLICATION FOR SANITATION PERMIT Permit No. .....�, C1.. ---------------- ------- ---------------- -------------- (Complete in Duplicate) " Data Issued .__ This s 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...__ 7 LszZ_____ __ •------__ _ _- Owner's Name.___._ ____ Address-----••-•- -------------------------------------- Contractor's Name -------------�- ! Pommercial PhoneM=�....- r. Installation will serve: Residence (Apartment House ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1----- Number of bedrooms-�Z___ Number of baths'__/-___ Lot size _.__��.A __ _________ 1 ___ Water Supply: Public system gj�-'Conimunity system ❑ Private ❑ Depth to Water Table ------- .ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe Hardpan ❑ �# -,Previous Application Made: (If yes,date____________________) No [L]`�_ New Construction: Yes Ef�No ❑ FHA/VA: Yes ❑ No 23--- TYPE 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_-Zti—_4.___Distance from foundation_ '_._-_._ .Material__ fQ �. _. ---------------- ® No, of compartments______-�----------Size___AX�X__�___-_:___Liquid clepth------ '/-_` Capacity---- Disposal Dis osal Field: Distance from n-earest well__ Rn--- V p �t ::Distance from foundation.)_®_____-..-__.Distance to nearest lot lin © Number of Imes-- --•---------------------- Length of each fine- , --- --------- Width of trench----./d --- - : --- { .r Type of filter material,___ s��lji :Depth of filter material---/ ------:----Totai Ian gth-------.��_ _____ ._ _. Seepage Pit: Distance to nearest welt______________________Distan'ce from foundation.._.._:___.._.{. Distance'#o nearest lot line................. i ElNumber of pits______________________Lining material-----------------------Size_Diameter______-_--_ Depth • --------- _Jt Cesspool: Distance from nearest well._____-_.-____.__Distance.from'foundation________________ __Lining material------------------------------------- ❑ Size: Diameter------------R--------------- '--Dep.h- ---------------------------------------------Liquid Capacity----------------------------gals; Privy: Distance from nearest well________________._.__- -_-----------._.__Distance from nearest building___.__________-_________ ----•----- ❑ Distance-to nearest lot line______________________ LL �. �* Remodglin and/or ring (describej:_ �✓�r - - ---- - s-3:_. '- 1-- /( 3=�--------- ---------------------------------------------- ------------ ---------------------------- ----- ----- --- -- -----------------------------------------------------------------------------------------------------------------•------------------------ ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances„/St to Jows, and rules and rLgulations of the San Joaquin Local Health District. (Signed I� ----------- ---- = ------------ V-�^�'--_. •--------------(Bwner-and �f Contractor) f ----------------------------------------------------------------------------'------------------------------------------------------ Tula (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- .__._1�-- ? -••---------------------- DATE--------- 7 REVIEWEDBY------------- --------------------------- --------------------------------- ------------------------------•--------------- DAT/-= = BUILDINGPERMIT ISSUED-------------•---------------------------------•----------------------------------------------------- DATE-------- Alterations and/or recommendations---------------------------------------------- - •--------------------------------• x ---------------------------- -----------------------------------------___________________________________________________________________________ ____________________________________________________________________________ __'_-_____._.____-____-___,________-_-.____._______--_-_.________ / r FINAL INSPECTION BY--------=--- -`: c � � Date......... 1 I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Jfj EH-9 WEVIBEC E-52 F.F.CC.2M$-50 ` { i i r