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,,,*r OR OFFICE USE: .....................=....... •- . ......._...-----•-• Permit No. APPLICATION FOR SANITATION PERMIT ..,[-. . (Complete in Duplicate) _ y . _> 7� _---- J ---- ----•- Date Issued - 44w, This Permit Expires 1 Year From Date Issued Application is hereby made to the San'Joaquin Local Health District fora ermit to construct and ir�ttail he work herein This application is made in compliance with County Ordinance No. 549.' 1 - JOE ADDRESS AND LOCATION_- --------_1 '.----lt Owner's Name..:-- ------------- Ponr ------ •--I-• -------- - Address__ •#/Od.. ;..............------------------- --•-- Phone..--•...... .:....._._....._... Contractor's Name... . Installation will serve: Residence Apartment House Commercial ❑ Trailer ourt ❑ Motel ❑ Other 0 Number of living units: _�...... Number of bedrooms .-S-. Number baths ...._.._ Lot size _... ...............................'--................. Water Supply: Public system ❑ Community system ❑ Private �pth Water Table -------- ft. I of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Character of sod to a depth ,��❑ I Previous Application Made: (If yes,date.....__�............) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.)- Septic Tank: Distance from nearest well_...•-•-.._. Distance from foundation_...__.-.----__-__Material_-_----._._•...._.-.-..�........._......._. -� ❑ No. of compartments-----.........:t........;-Size"..-!__---. -..•:.....- Liquid dept--................._.___.Capacity...__.._.--=--.. :1 • 9 Dispo Field: Distance from nearest well...... Distan a from foundation_____l.>g........Distance to nearest lot;line___.,T....... Number of lines__.._!__ Length`of each line--W.. �.. Width of trench. - .................... Type.of filter material__A:. _., Depth ;f filter material......./,X....... . .. ._Total length......./4940.. ............... .. Jwugu ~ Distance to nearest well.... ."...distance from foundation.._.-"�0_..._.-Disytan to nearest loUline A$--_"_.__ G [] 4, of pits-------- r aterial�_�eQ_.L�.:......Size: Bisflae+er�.r�t-- .--.Depth_----.-- -_--_ ----•------ i. . -* Cesspool: Distance;from_nearest well----f.__--.•_•:)Distance from foundation____..••:_..-__.__..Lining material.............------------.------_.. Size: Di __.-:........ --.....IDepth --.--"---------------------•- --- - q p ty....... ,...gals. ❑ r .Li Uld Ca $Cl Privy: Distance from nearest-well.:`- ............................__-..Distance from nearest building-------.------- _ [] '---Nstbnce t earest4► t-line.......-...-.; -- )--------•----•-------------------------------- - - --._._......---•- Remodeling and/or repairing (describe):............... { ..................................... -... --.__ ....._._.. -- ..._. _ ---------- I �... —---.--_.._.. •-•---...... _•............_............................................••----• � - . .... - ---"------•-------".............:........................••----•---•-------•----.____-------•---------•-------------------------------------------------------------------------------- ------------------- 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 regulations of the San Joaquin Local Health District. (signed) -- .............. -. - ( /or Contractor( By:------- - - .--------•--•--------------•(Title)----- -- •---•---------- -............ .__- ._. ---- _(Plot plan, showing size of.lot. (ocation.of sys em.in•relatio to-wells, buildings, etc., can.be.placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY.... ..... .... . ........ `_...-------------------------------------------- DATE--.7-•`- '---•-Y-..._...--_••__..-. REVIEWEDBY----------------------------------------_..............................................................-_......-•"_ DATE........_-...-.. ,-.-_. ...---_•......-._..-.. BUILDINGPERMIT ISSUED--------------•----`--•----= ----------•---------•- -- ...... DATE__...:......--......._......................._..._.. - Alterations and/or recommendations:...t.-...._.•._.:_._..................... ...._.._...._................._._....._._......._--....__..__.--...........__... ----"..--••------...............•---------------- ...................................-:-.......................................----..................................................................................... FINAL INSPECTION BY: - _----------------- ._. Date...... .fib'lt-1*1...................... SAN JOAQUIN LOCAL HEALTH DISTRICT _1ti01 E.Matette_n Avg. 300 West Oak Street 124 Sycamo_re.Street -205 West 9th•Street---� Stockton,California Lodi, California Manteca,California Tracy,California E5 9 REVISED 0-59 3M 3-•63 r.P.Ga.