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OR OFFICE US Y �'.___._11S_ i�_ APPLICATION FOR'SANITATION PERMIT Permit No. ' - - --- ------- (Complete in Duplicate) $`_( z ��1 '� . ,This Permit Expires i 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 CouJy;Ordinarl No. 549. r F { JOB ADDRE55 LOCATION- ✓ - '••--_- -•---- fj,,,� f r Owner's Name-___• T�"r'r` - ------=---------------------------------------- - Phone -•--•---•---•---- Address. ---•• ---- " - -----------•----------------------------------- Contractor's Name-------•-- �� ---- -----------=------------- -------------------------------------------- Phone---------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ElMotel ElOther El Number of living units: __ __ Number of bedrooms_ Number of baths 1-,0f— Lot size �Q; _. er____________________-__ Water Supply: -Public system E1 Community system ❑ Private'.A-'6epth to Water Table .(�3_?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Rg-'V`ardpan ❑ Previous Application Made: (If yes,Bate.............:------) No [I;--"New Construction: Yes 2;,-INo ❑ FHA/VA: Yes [Z--4Alo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perrniffed-if public sewer is available within 200 feet.) Septic Tank: Distance from nearestwe I----��____Distanc_e from foundation---Ap-------Ivlatersal__ _ ,��` � �---------. No. of compartments_ _-__...____._____.Size �ti'�_ Liquid depth______�",/0'.?..-_ P y Ca acit ,f - .__ Disposal Field: Distance from nearest well_-- - .'Distance from foundation___ ,__ �� --- P � f -- -Distance to nearest ]of ine_ � _..a�D__�___..___ Number of lines-__.____t�/ �_________ Length of each line-MV" of french.-_- Type of filter material Le- ( Depth of filter. matercal___.4�-___-------- length__ - ______________________ Seepage Pit: Distance to nearest well_/ Distance from fou dation___, � Distan�a to nearest lot line-47"_-_ Number of pits_...__________Lining mat erial__10V0 -Size: Diameter._ ' Depth- Cesspool: Distance from nearest well----------------- from foundation------------- _----.Lining material___________________________-_______ ❑ Size: Diameter-------------------- -------=------Depth----------------------------------------------t - Liquid Capacity----------------------------gals, ti Privy: Disfance.from nearest well------- -------------------------------.-._Distance from.nearesf budding------------------------.___-----_-_--.._. ❑ Distance to nearest lot .. linCe----------------------------------- N- r, Remodeling and/or repairing (descri -----• ------••-•---------==----------------------------------:-=-------• ------------------------- ------------------ ---------------w-- ----------------- -------------------- lt --------------------------------------------------- -----------------------------•---------------------------------------------------•---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - ----- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reguI ions of the San oaquin Local Health District. I (Signed)------------------------ ----------/ �� - -- -- --- --------(�r Contractorl Br ----------------------------------------- - __-(Title)_ , --------------------------------- (Plot plan, showing size of lot, location of system in relation to s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------A�(---- --------------------------------------- DATE---- ------------------ --- REVIEWEDBY. ------- ------------- ----------------------•--------•----------- DATE------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------- r -- ,____J_._______ 4DAIE - ________________ Alterations and/or recommendations:__ � - —--------- ... . - •------------ FINAL INSPECTION BY:.f�G� - -- ---------- Date ---- SAN JOAQUIN LOCAL HEALTH DISTRICT xr 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t Stockton,California Lodi,California Manteca,California Tracy,California FS 9 RE 'MD 9-s9 3M 3-'63 F.P.CO.