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FOR OFFICI`USE--74'" f ------------------------------------------ -------------- APPLICATION FOR SANITATION PERMIT Permit No. O_J_. r -------------------------------- (Complete in Duplicate) Date Issued ---- -!'--�� _ __ _------------ This Permit Expires 1 Year From bate 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. TI �� JOB ADDRESS AND LOCATION.. . _ -- ------- --------- Phone--- Owner's Name------ 9 Address - J f----- ----------- -- 4 --------------- Phone.3-1°- - JS/z Contractor's Name---- •- Installation will serve: Residence ❑ Apartment House P-t1m, mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -<q-- Number of bedrooms _3-- Number of baths - -- Lot size ----- _ Water Supply: Public system ❑ Community system ❑ Private [ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Pa-'6ay Loam [I Clay ❑ Adobe E] Hardpan F1Previous Application Made: (If yes,date---------------- ---) No D�New Construction: Yes El No [iIFHA/VA: Yes ❑ No ❑ TYPE OF-INSTALLATION AND:SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ti nk: Distance from nearest well-----------------Distance from foundation--------------.-- ..Material......--_-......__.....-..-.-......____---------- No. . -.-----No. of compartments--------------------------Size------------------------•-------Liquid depth--------------------------Capacity----------------- - - Disposal F• d: Distance from nearest well-,S_Z�-..... Distance from foundation-_.�Q--------Distance to nearest lot Number of lines.--..: —-- ..Length of each line---- U_Q.-`_. ...Width of french------��--y...-- I Type of filter materiaL...Sr_ Q__1C Depth of filter material-.... 1 __--..--Total length---.--.-----Z-4---Cl--------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_....----...- .. ❑ Number of pits. ................ ..Lining material---------- ------ ---..Size: Diameter-----------------------Depth---------- -------------------- Cesspool: Distance from nearest well---------------- Distance from foundation--------------------Lining material--------.--_-.-------.-_---.----- . ❑ Size: Diameter.. --------- Depth----------------------------------------------------Liquid Capacity----------------------------gal . Distance from nearest building Privy: Distance from nearest well---------------- ------------ ---------------. . ❑ Distance to nearest lot line-- --------- -------- ----------------------------------------- 1 Remodeling and/or repairing (describe)------------------ ---- ------------------------------------ r -----i -----------•------------------------------------------------------------- ---------------- --- ----------------------•-------------------------------------- ------------=------------------------------------------ --------------------------------------- -- I -- ------I------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, nd rules d reg tions of the San Joa uin Local Health District. (Sgned) ---- --- ----- _� ------------------ i - -- _ T - � (Title) -- .. caner or on Plot Ian, showing size of lot, location of system in relation to wells, din s, etc., can be pi ed on reverse side). ` ( P g FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------T-� DATE-------- �.."- fes --- -- - � DATE------------------------------------------ ----------------- REVIEWED BY------------------------- --------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- -------------------- - DATE -- Alterations and/or recommendations:------------------- ------ -------------------------------------------------- ----- --- ------ FINAL INSP ION B -- Date r �g -�� -- --- - --- --- ---- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street • 205 West 9th Street Stockton,californi. Lodi,California Manteca,California Tracy,California F.F.CO. I