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FOR OFFICE USE: APPLICATION FOR—SANITATION PERMIT Permit No. _ .�... I- (Complete in Duplicate) r This Permit Expires 1 Year From Date Is sued --------------Issued �7______- 2_0 Application is hereby made to�;the San Joaquin Local Health District for a pe it to constrict-a_r}_dajnstall the work herein descrbed:` This application is made in comp pliance with County Ordinance No. S49, �f a/.q j-5S. mJ° GS 7-P c�F ---w e c r Zs /J < ) JOB ADDRESS AND ,L )CA TIION- --- .- •_.--4 ? -1` y� Owner's Nam /�'___------ ------( -- ------- -------•-- - - ---------------------- -- ----- ------ Phone___.. •--...-•-------••---•-------•-- ssAddre --•--� �� ------• . P - �- ------------------------- -------------------_ Contractor's Name-----------1- ---- --------- ---•---------------------------------------- ------------------ ------------------------- ------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other ❑ Number of living units: h l )-.._ Number of bedrooms . Number-of baths ./_____ Lot size _ � Q__1`f.'? t_________________._.__ Water Supply: ' Public system ❑ Community system ❑. PrivateDepth to Water Table ft. Character of soil to a depth o1f 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay Adobe❑ Hardpan C];1 Previous Application Made: (if yes,date----- ----------_ -) No� New Construction: Ye� No ❑ FHA/VA: Yes E] NA TYPE OF INSTALLATION AND SPECIFICATIONS: :--(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep i -Tank: Distance fmom nearest well___ 40...Distance foundation_____JL _,____.r � �at rial____� Ca P alit.Y _- -- No, of co" partments_._____-____-, e �_ _Li uid de th__� _ -_______--- Disposal Dis osal ... Field: Distance fpm nearest well ... __Distance from foundation__'y_ ____.Distance to nearest lot Ii -Jb 0 `� Number ofil linesJ ______ ___ J-___Length of each line__.--_`_r___.___.Width of trench____-Z- -____.____-____ yy// �S Type of filter mal 7 f.-_Depth of filter material-_�---- -_-.Total length____. __` _____________ ______ "� Seepage Pit: Distance to? nearest well----------------------Distance from foundation___________________Distance to nearest lot line--_____________._ ❑ Number of pits----------------------Lining material---------------------- Size: Diameter.------------- --------Depth--------------------------------- --� 4 Cesspool: Distance from nearest well-________________Distance from foundation-------------------- material____-________-_---_-___________.___. ❑ Size: Dia deter- ---------- - Depth ------- --- --- ---------------Liquid Capacity----- ---------------gals. Priv-y Distance frore m neast-well ____ --__ -__------------Distance from nearest building------------------------------------------ ❑ Distance A nearest lot line ---- ------------ -------------------- ------------------------------------- Remodeling and/or repairing describe):__f;-)0----------- - ------------------------------------------------------------------ ---------•-------------------------------------------------------- �---------------- 1 Hereby certify that I ha a 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)..-_... `' ---- V -------------------------------------------------------- --- --------(Owner and/or Contractor) a B • Title (Plot plan, showing size of lot i cation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-__--___-._ _ DATE______ __ REVIEWEDBY------------------------- *-------------------------------------- ---------------------------------------- DATE ' A BUILDING PERMIT ISSUED - --------:---------- ----- ------ -------- ----- -- _�-JDA•TE --- -------------------------------- Alterations and/or recommend`ations-------------------- --------------------------------------------------------------- --------------------.----------------------------•------------------- q-� i ----------------- -----•- -------------- ---- ----- ............:........ --- i FINAL INSPECTION BY:----_,_ _ / i - -- --- ---------------------------------------- •-- ' Date-------------/--� .--/� -__�-.�--------------- §AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD.