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FOROFFICE USE: -- ------------ - _- ---_--_-_ __--------- -------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------- (Complete in Duplicate) - / D ..................... This Permit Expires 1 Year From Date Issued j f�j at issued "_!__ Z-1 !I I/ - /9 v &S—pit 0-2.7 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 Min-compliance with,Count _Oydinance No. 549. /C.- 7 �l JOB ADDRESS AN OCATION________ Owner's Name -19 /5----... _ /�---------------••- ------------ - Phone------------ ----- - -------------- Address----------------------- --- - ----- Al- 0- -------------------------------------------------- Contractor's Name____ _. ___. - • ------- ------------------------------ --------•----------•-------------------------------- Phone----------------------------------- Installation ---....--------------- ••- - ---•Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: /____ Number of bedrooms-_ Number of 6aths,,,3- ___ Lot size __ ---------_ _�?2�4---------------------------- Water Supply: Public system E] Community system [I Private epth to Water Table ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobelardpan Previous Application Made: (If yes,date___________ ________I No New Construction: Yes - to ❑ FHA/VA: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well__ ------- Distance from foundation--/ ------Material------- ---_BipL__-__� (n�.J No. of compartments ___-.----Size-_ __ ! p .�&��- ----Liquid depth 7-1i-------------Capacity---�-'-�-----,--- Disposal Id: Distance from nearest well_-- 1-__Distance from�+f,� notion -- - Distance to nearest lot line___ _______ Number of lines------------- --------- --------Length of eaL Xe_---- ------------ --Width of french----- ----------------- /l i r f Type of filter material.__1-.��_____________Depth of fitter material_----f __Total length_-_-_- -a __.-__________._______ See,p�a,�g it: Distance to nearest welt__ %_- ___Distance m foundation__- Q- ___.Distance to nearest lot line__6_ _ 4 r ;) Number of pits-___ �/.....Lining material___ /_..Size: Diameter___=�_'.�_.___Depth_ S._�_f Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------------- El Size: Diameter--------------------------------------Depth-------------------------------------- -------------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well----------------------.----___.--------_�_.wDistance from nearest building____._______.________________--_.------- . Z ❑ Distance to nearest lot line-------- --------- ---- -- - -------- ---------------------------- '------------------------------------------------------ ------------- Remode4ing and/or repairing (describe)---------------- - r r+�� ------------------------- -----------------------------------------------------------------------------------------------------------------•--------- ------- -- --------------------------------------------- --------------------------------` ----------------------------------------------------------•----------------------- - -------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 rul d regulations of the San Joaquin Local Health District.— , ($igned)------------ ____!� ��_ _______._.__ 4. .,_(,00wwner and/or Contractor) y BY:--------------------------------- � {Title}_.. ' (Plot plan, showing size of t, cation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -•------ ----------------- ------------------------ ------ DATE------�_`_�_4-r _ --------------- -- ----------- REVIEWEDBY--------------------------- ------------- -------------------------------------------------------- ----------- DATE------------- ------------ BUILDINGPERMIT ISSUED---------- -------------------------------------------------------------------------------------------- DATE----- ------------------------------------------------------ Aiterations and/or recommendations---------------•---------------------- ---------------------------------------------------------------`------------------------------------------------------- ----------------...................... �------- -----•------------------------------------------- ------ FINAL INSPECTION BY:.._[_.'.-.: .� --------- Date...._--?f7� — 5----------------------------------- SAN ------ -SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazelton Avrr. 300 West Oak Street 124 Sycamore Street 205 West 9th Street c' Stockton, California Lodi,California Manteca,California Tracy,California