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OR OFFICE USE: --------- ----- Permit No. .l_�--3 � -------------------- -"----"-- _ __. APPLICATION FOR SANITATION PERMIT q� - ----------- -- -------------- (Complete in Duplicate) Date Issued -------------------------------- 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 wit County Ordinance No. 549. JOB ADDRESS AND CAT '---- --- �Y'l Phone------------------------------------ Owner's Name. ------- Address.___.._ __ - --- --------- ---- Phone--------- ------------------------ ---------------------------- ----------------------- Contractor's Name________ . ---- �/ -------- ------------------- - --- ""- """------- - • - - - - Installation will serve: Residence g2-"'Apartment House El Commercial ❑ Trailer Court [I`Motel El Other ❑ Number of;living units: _ ..__"" Number of bedrooms -- Number of baths -Z- Lot size --------------------------- Water Supply: Public system ❑ Community system ❑ `Private Depth to Water Table 0/7`�/`ft. Character of soil to a depth of 3 feet: Sand E] Grave! El Loam ❑ Clay Loam ❑ Clay . Adobe C] Hardpan ❑ Previous Application Made: {If yes,date----- ---) No 171,-"New Construction: Yes E] No JP/FHA/VA: Yes [I No TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tarl + Distance from nearest well--------- from foundation__."-"-__ _.____.Material""_---._"____"-------------------------------- � ,� No. of compartments---- --------------------Size----------------------------:---Liquid depth-------------- -----------Capacity----------------------- ,.,/ Distance from foundation-__ _.�"-. Distance to nearest lomat line.__1 ""�. Dis sal T I ld: Distance from nearest well. , Number of lines":�__ - --- .k�--: Lengfh of each line,V-`__ -`--.Width of trench._ .._._7._____.__._____-.-- �IJO Type of filter material.j/ Epth of filter material _- --.Total length---f_ --------- t __Distance from foundation _____".Distance to nearest lot fine----_________-" � eepage Pit: Distance to nearest well______________ ---.---Size: Diameter -----------------------Depth--------------------------------- ❑ � Number of pits---�------------------Lining material----------. --- t Cesspool: Distance from nearest well----------------- from foundation- ___-_. .Lining matenal______________________________________ Size: Diameter_."I--- --- --- -------Depth - -- -------- -- ------------------Liquid Capacity gals. r .. - Privy: Distance from n Zarest welt------------------------------------------ Distance from nearest buildin ❑ Distance to nearest lot line----- -- ---------------•------------------ --------------------------- 0/ 4 ,t ---------------------------------- Remodeling and/or repairing (describe]:----._.-._"-_________ V �- w� `� "" ------------------------------------ - ----------------------------- -- - --------•--------•------------------------- I hereby certify that I have r l -----— '------- --------------- --------------------------------------------------------------------------- co a --- ui y y epared this application and that the work will be done in accordance with San Joaquin ounty ordinances, State laws, and les and regulations of the San Joaquin Local Health District. ,. -------- --- ----------- --- Owner and/or Contractor) (Signed)--------- ---------75;zeof4ot�, BY� -------(Title) ��-- �------ ----------- - (Plot plan, showing location of system ' elation to weNs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` - ------------------------ ------ DATE------------------------------------------ -------------- -- APPLICATION ACCEPTED BY__.____.""--"--------- --------- _ --- 6 -- --- ------- REVIEWED BY--------------------------------------------- ---- ---------------------------------- - -- - ATE . - - � f ---------- BUILDING PERMIT ISSUED-------------------------------------------------------- : ATE--- 1. - Alterations and/or recommendations--------------------- ----------- -----------------------'------------ -------- --------I-------- ------------------------------------------- ------------------------------------------------------------------ FINAL INSPECTION BY.. "--- - Date , r 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 r.P.co. i