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FOR OFFICE USE: --------- - -------=---------- ----- ------ ------------- APPLICATION FOR SANITATION PERMIT _.Permit No. x.7.-91. _ - (Complete in Duplicate) Date Issued ___�?l,��f 1 _ - -------- - This Permit Expires 1 Year From Date Issue C)6 _ 7-10— 3S ed. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ This application is made in compliance.w•th County Ordinance No. 549. JOB ADDRESS AND LO Owners Name___ =--- -fir` y� _ Phone • ---------- -- Contractor's Name------ ---- ------- ------- - ------- -------------• Phone Residence 'A artment ouse ❑ Commercial ❑ Trailer Court Motel ❑ Othe Installation will serve. ❑ P Number of_living units:---_---- Number-of bedrooms ---_----. Number of bath l Water�Supply_ Public systerrl ❑ Community sI _mystem ❑ Private Depth to ater Table -_-(J-- t+• 3 _ Cha`ccter0. yof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ ! No El Previous Application Made': -11-f yes,d-ate----------- --------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ i i � � � TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic'tank-or-cessm pool permitted-if public sewer is available within 200 feet.) } ��.. earest well:'--_._._r"'.�-'Drstance from foundation-------------------.Material-----__------___--- ___"-----..----. Septic Tank: Distance from n . - ;. E] NO. of compartments--------------------------Size--------• -------------------- -Liquid depth----------- - ---------Capacity------------------- -� Dispos Field: Distance from nearest well----5O."_-D.isfance from foundation--------.�_2?"�_Distance to nearest lot line-----��. Number of lines-- ---Length of each line_ �.W'rdth of.trench-.,.---- --:------------------ Number _..---- -._-.- �� Type of filter maferraL__- r-iC__ .--_Depth of filter material- _8_ Total length---.- -- -.�______-- ------ ----------------- Seepage O See a e Pit: Distance to nearest well--- ------------------Distance from foundation--------------------Distance to nearest lot line__-----.-_--_-.. � P g Depth ----- ❑ Number of pits__-"__:______.. --_--Lining material-_--__________________Size: Diameter------___-._._.._. ; Cesspool: Distance from nearest well--------------- -Distance from foundation--- ------------- Lining material----------.--------------__.--_---_-- ❑ Siie: Diameter-----' ------------------------------ Depth----------------------------------------- ----------Liquid Capacity----------------------------gals. `I Privy: Distance from nearest well--------------------- Distance from nearest.building-------------------- --------------------- © s ❑ Distance to nearest 4ot line.---_-------------------------------------------------------------- --------------------------------------- -------• �E Remodeling and/or repairing (describej: ---------------------------------------------------- -------------------- E ; ----------------------------------------------------------------------------- c ------------ .. ---------------------------- -- ---------------• --------------- -----•-- ------ ----- I hereby ce tfy:t at I have prepared this application-and that the work wilt be done in accordance with San Joaquin County ordinances, Sta a laws, nd rules and regulations of the San Joaquin Local Health District. s� __.-_ .-- (Owner and/or o ac - ' - --- --- - ------------------------------------------------ ----------- &P ntr ---------- - =----------- - (Signed)------------��J -- - - �.. r -. r (Title] .p. -. -.- - -- or ' .t a By:-------------------- --- ----- ----------------------------------- (Plot plan, showing si a of lot, o aticn of s stem in re ation to IIs, buildings, etc., can be placed on reverse side). �r ' FOR DEPARTMENT USE ONLY ��// Al ---------------- DATE----f'=! J."------------------------------ APPLICATION ACCEPTED BY--__ - -- - ----- - - DATE-------------------------------r----------------------------- BUILDINGPERMIT ISSUED-------------------------- -- ------------------------ --------------- DATE----------------------------------------------- ; Alterations and/or recommendations:------------------------•- ------- ---------------- -------------:----------- --------------------------•-----------=-- ------=----------------•------------------- --------------------•------------------=------------ --- -------•-------------------------------------------------------------- FINAL INSPECTION BY: _ "'� - ---- --------- --------- Date-- - -----�- -�C- ----- ----- -------- ---------------------------- FINAL ------------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REV$SEO a-Sg,3M 3-s:a r'.pxm.