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v FOR OFFICE USE: -------------- .......--- N� APPLICATION FOR SANI-TATION PERMIT Permit No, 4�ZeOOl ' ----------- ----------------- ------- ---------------- (Complete in Duplicate) --.--- . This Permit Expires 1 Year From Date Issued 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 with County Ordinance No. 549. JOB ADDRESS AN OCATIOI\, Sff r„a Owner's Name Phone-_-,------------------------------ I Address F•- �+�-�� rl�r_.. h"�4F----------------- Contractor's Name------ - ---------------------------------------------- Phone--------------_ -- Installation will serve: Residerice ®/Apartment House ❑- Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: ..- .. Number of bedrooms J' /. , Number of baths ..�.._ Lot size ,/TGfi>�iE'r :_'--- Q' '-_-•--.__•_ Water Supply: Public system ❑ Community-system 1❑' Private Fro"Depth to Water Table -�/Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel.❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z?-'Rardpan ❑ Previous Application Made: (If yes,date....................1 ..No New Construction;i' Yes ❑ No FHA/VA: Yes ❑ No ©_ TYPE OF INSTALLATION AND SPECIFICATIONS:- (No septic tank or cesspool permitted if public sewer is available within 200' feet.) �S! c4 k: Distance from nearest well--------- --Distance from foundation°-------------------Material....__.._.....-_- _..-.. S! �tic "a No. of-compartments Size--------------------------------Liquid -----------------depth------------------. Disposal Fie! --------Capacity-••-------------------- Dis • d: Distance from nearest well.-111i---- Distance from foundation-./Q_-.......Distance to nearest lot line._1�.P__-... i w Number of lines..-. _..___... ength of each line.... � _ Width of trench.,_-�__-- ` Type of filter material ... -�?C f � - Depth of filter material_ ---___----Total length.- :-------_ ---------------- Seepage Pit: Distance to nearest wall----------------------Distance from foundation--------.-----------Distance to nearest lot line----------------- n Number of pits-- ------------------Lining material-----.-----------------Size: Diameter--.--------....------..Depth.-------------------_- Cesspool: Distance from nearest well------------------Distance from foundafion....- ---.......Lining material-...-------.. . ❑ Sizer Diameter--t--------------- ------- -----------Depth----------------------------- --- ------------------Liquid Capacity----------------------------gals. Pris y: Distance from nearest well ................._...__-.____..__-.__,__-Distance from nearest building__--- -------------------------------- El ---.._...---- - ❑ Distance to nearest lot ine------- s Remodeling and/or repairing Idescrb :-- ---- ------- 6/Y` j- -------------•----------------------------------------------------------- -------------••---------------------------•--------------------------------------------------------------------------------------------- --------------------•----------------------•--------•-------------------------------------------------------- ---------------------- ----------- ------------------ -------------------------- ----------------- r x .........---------------------------------------._--.--------._..-----------------------------------------------.----------------------------------------------------`---------------------------------------- - a 1 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}-• Q/(/.-' .�Q -------------------------------------------------- ( r Contractor) F By:------------------------------------------ ---------- --------sy r (Title} �, --- - ------------ (Plot plan, showing size of lot, location of in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTEDBY REVIEW ,- EDBY--------------------------------------------- ---------------------------------------------- ---------- ---------- DATE - ---------------- ----- UILDING PERMIT ISSUED ---------- ----- ----- DATE-------------------------- Alterations and/or recommendations:--------------------------- -------_---------------.-----_---_-------- fi -------------------------------------------- --------------- ------------------------------------------------------------------ -----------------------•- ---------------------------------------- ---------------------------------------------------------- -------------------------- -- F. O FINAL INSPECTION BY:. --------------------- Date....4_-a� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ! Stockton,California Lodi,California + Manteca,California Tracy,California F.P.CO.