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FOR OFFICE USE: -- ---- ---- APPLICATION FOR 'SANITATION PERMIT -- - - - - � Permit No. � .�� ------------------- ------------ --------------------- (Comple+e in Duplicate) Date Issued l/= This 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. S 4 o --�---- --'------------ rr - JOB ADDRESS AND LOCATION. �4?4 t� S Os Name----- 5c� _h�,----- (� .Ce ----- wnerPhone_ f 'r -----------[ �i ----- -------------•--•-•----------•-- Address.----- ! Phone Contractor's Name-- -----�'•=- -----------•------- -----------------------•----------------------------- - ---------------------------------------- Installation will serve: Residence Apartlment House F1 Commercial F] Trailer Court ❑ Motel [I Other ❑ Number of living units:_�____ Number of bedrooms : _.- Number of baths __1____ Lot size ------- Water Supply: Public system [X Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑` Sandy Loam.;g Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes date_____ _____________) No I& New Construction: Yes ❑ No ;W FHA/VA: Yes ❑ No # TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if,public sewer is available within 200 feet.) _- •-------- ------- Se tic Tank: Distance from nearest weil.�a41 Distance from foundation--___J_--__---.Material-_ , ` 44 p No. of compartments-.-- .- ----Size------•-------------------------Liquid depth--------- --------Capacity----------------------- 1 i posal F`iel� Distance from nearest wellO�---Bistance from foundati n__. -f.--------Dis#ante to nearest lot line__s-�--- 0 *^iy------- ---Width of trench.--- --.------ .-__---- Len th of each line___ _. -____..___ Number of lines____.________ __ _____ g �� Type of filtbr�material._ e - p / ----Total len th__ •` Depth of filter material-.---- -��-- 9 #ld--------- --- �1 Seepage P t: Distance to nearest#.well______________________Distance from foundation--------------------Distance to nearest lot line ____-_______.-._ ❑ ---- Depth--------------------------- Cesspool: of pits-----��--��-.�--Lining material-----------------------size: Diameter------------------ I Cesspool: Distance from nearestw ekL_______________Distance from foundation-----------.--------Lining ❑ materia __ ..__-_.---_-_.___.--..___-_____--- Size: Diameter --.Depth-------'- ------------------------------------------Li Liquid Capacity gals. -w _fronearest building -------------- Privy: Distante=from-nearest,"e __- Distncem .' ❑ Distance to nearest lot line------------------ ------ ' ------------------------------ - Remodeling and/or repairing (desc;ibe):_ ----- -� 1'r> ---------------- -------------------------------------------------------- _ . 1 4 • --------------------------------------i--------------------------- --------------------------------------------------------------- --------------------r---------------------------------------------------- ------------ ._ hereby certify that { have prepared this a---------- -on�a`nd }� - --------------i - - -- - y y p p pp at the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned ---------- --------------------{Owner and/or Contractor) ------ ------------------ - ----------- ---- (Plot plan, showing size of lot, Iota+ion o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY L APPLICATION ACCEPTED BY---- ._. ----- _.----------- ----------- -------------------------- REVIEWEDBY----------------------------------------------------' ------------ ----------'-------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------------------- --------------._ -------' DATE-- --------- --- --------------------------------------- Alterations and/or recommendations---------------------- ------------------------------------------------- ------------ ------------ --------------- ------'------------wvccc `l--jFINAL INSPECTION BY:.- _.._'__._ Date------------- ------------------ , A � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California ._X.