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- ...,_„ -� ------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ . --- ---- ,. .(Complete in Duplicate) ------ This Permit Expires 1 Year From Date Issued Date Issued//-/ -_ 45f Application is.hereby made to the San Joaquin Local Health District for a permit to construct and install the work here described. This application is made in compliance.,,With County Ordinance No. 549- �,,J JOB ADDRESS AND LOCATION- �" - + Ow ------- ner s Name- _ _ _ - _ w µ --------r- --- - Phone .'.-=H __: Address = AD -- - - ---`--••-------------- Contractor's Name------- ----- - _-_5--------_= - ------------------ -------------------------------. Phone---•------------ Installa#ion will serve: 'Residence Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel [] Other Number of living units: ---/-- Number of bedrooms -_umber of baths __/._ Lot-size -----a-ta1,. _,p,. Water Supply: Public system ❑ Community s - y stem y ❑ 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-ApplicationrMade:-(-If-yes-,d cite!;_ ---). .No-❑-i----New-Gonstruct•ion:-Yes TYPE. OF INSTALLATION AND SPECIFICATIONS: SOT❑ FIdA/VA:FYes�❑ No ❑ } t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well----- --� Distance from/fou_ndat.iLoinq_ui-d-�- - _Materiar l---_No. of compartments---------'�----------Size X --- -. r , oaf ✓depth------ --- --- Capacity--4;>. , f Dispos field: Distance from nearest well- -_.-_Distance from foundation._-. it---_---.Distance to nearest to li��-k___ Number of lines__-.-_ - 1- -- -_ .--Length of each line z 'r. Width of trench-.-- Type of filter material-- S'- Depth of filter material----- g �., -------- Total len th0 -� Seepage Pit: Distance to nearest well_--------------------Distance from foundation--------------------Distance to nearest lot l ❑ Number of Pits-------------- "--__-Lining material--.-_-.__.-- - _ _. - -----Size: Diameter-- ---------------- ---Depth-------- ----------- -------- Ce , sspool: Distance from nearest well-----------------Distance from foundation---------------------Lining materia----------- Size: ❑ Diameter------------------ ----- -- ---- ------------------Depth------- -F---- Liquid Capacity-.---------- ----- --------gals. Privy: Distance from nearest well--------------_---_------------ I --____."___.-.__Distance .from nearest building----------El - Distance to nearest lot line-__."---___--_:__----__. --------------------------------- Remodeling and/or repairing (describe) __ ___ r . ------------------------------------------- I -------------rr�_7a_ 9 '-- _---------- - - -- -- - - -- - I hereby certify that I have prepared this ap lica+ion and that the work will be done in accordance with San Joaquin County ordinances, State law , ules and re ulati sof a San Joaquin Local Health Disfrict. F f - - : == . : _ - -- By:.------ n or Contractor) --- -------------------------------------(Title)-------------------------------------------- -------------------- --------- (Plot plan, showin size of lot, location of.sys+am in lation t ells,.buildirtgs, etc:, car}'be'placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWED BY -- _ f ------------------------------------------------------------- QA7E /�'7_.� --�r -— - -- ------ - - - - DATE__.------ ---------------- BUILDING PERMIT ISSUED -- --------------•= •------------ DATE Alterations and/or recommendations:--___-_-- --- _ f li -------------------- ---'- .-_..------------------- FINAL INSPECTION BY:- �� .1,.� Y --_ - Date /0---= - - - ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasettan Ave. 300 Wes►Oak Street 124 Sycamore Street Stockton,California Lodi,California 205 West 9th Street Manteca,Caiifornio -. Tracy,California ES 9 REV'SED 8-59 3M 3-•63 F.P.CD.