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jF,PR OFFICE USE: ------------------ ---------------------- _�- -_ ),APPLICATION FOR SANITATION PERMIT Permit No. ------ ---- ----------- : ----------- ----- (Complete in,Duplicate) P Date Issued ---� � ------------------------------------------;__.:__._.--. This Permit Ex ires7'I Year From Date Issued Application is hereby made to the San Joaquin Local Healfh'."District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc No. 549. JOB ADDRESS AND OCA ION------- ------ 11` r -------- ,_ _(]�K---- ------ ---------------------------------------------------- Owner's Name -- ----- ------#--- ---- •----- Phone------------------------------------ Address------------------ ------ -----------------•- Address------------------ -------------------------------•-•------------------------------------•----------•-•------------------------- Contractor's Name---------••-•--• Installation will serve: Residence �` Apartment House E] lCommercial [-] Trailer Court El Motel ❑ Other ❑ Number of living units: �_-_-.Number of bedrooms -t�-:Number of baths ---/_ Lot size ----- Water Supply: Publics system. ❑ Community .system ❑ Private Depth to Water Table-�',d, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,' Hardpan ❑ s . Previous Application Made: (If yes,clatelq'.S _>_..) No 0 New Construction: Yes-❑ No FHANA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: ' I 4N10ptic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well___-------------Distance :from foundation__--_-___-----_---Material_--..-_:_____rNo. of compartments ---------------------------Size---------f----------------------Liquid de th_-----------_-- ----Capacity 9 P P Y =s Fief Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line__.___-__-_------ Number of lines---------------------- - - -_Length of each line------------------------------Width of french-------------•---------------------- _ Type of filter.material_- �--.. __.--_-_Depth of tfilter material--------.-------_----- otal length__________________ __ ----------------- .117 Distance to nearest/well _Q�_____-�Distanc m f unclation---.7S-__-_..Distance to nearest lot line-6---[1__--._ Number of'pits.---4-/.............k rring materialO_UNSize: Diameter_-_�-13...... Depth_ _____________________ i Cesspool: Distance.from nearest welL �`"__._- Qi"stance from foundation--------------------Lining material--------------._____-_.-_-____-___.__ Size: Diameter_'- - - `__`"� _ \._ Liquid Capacity ❑ Qeptil -- ----------- ------\M ---.----------- -- q P Y------------ -------------gals. Privy:.. Distance from-nearest well _ _- _--------- Distance from nearest building.._ --<-------------...................... �► ❑ a , s Distance to nearest lot line_.-. = - - ---- ----------- f. -- Remodeling and/or repairing (describe):----------------------- ,f '. is 5 x � r � - -------- ---- -----------------------:------------------------------------------------- --------------------- ----------------- ----- -------------------------€--- -------------- L.- --•------------- - -------•---------•------------------------------------------- --------- I here y certi that Fhave prlepared #his application and that the work will be done in accordance with San Joaquin County ordinance aws, and r les and ulations of the San Joaquin Local Heal#h District. w (Signed)-- -- - - ner and/or Contractor) r ; $ w Plot Ian, showing size of.lot,.location of..`ij tern in relati to wells buildin 's etc. can{Title--- - = { P 9 � • �. Y � gt, be placed on reverse side). "%FOR-DEPARTMENT USE'ONLY APPLICATIO.N'ACCEPTED"BY--------- --------- - J----------------------------------- DATE---------1/--- �f I REVIEWED BY - ------------ DATE------------ = BUILDING PERMIT ISSUED-------=------------------ ----- - ----------- ------------:------ DATE------------ ,l #ion r.recommen ------------------------------------------.- Alterta of d o atians:- r ------------------------------------ -*------------ ---------------------------------- -------------------------------------------------------------- -------- -------- ------------------ -- - --- 7--t = - -- ----------------------------------------------- - FINAL fNSPECTION BY �� t ----------- ----- - ------------- Date--- r'- `.. ........ ---- -- --------------------------------- 4E. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Av. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 nEV16LO B•59 3M 3-'63 F.P.CC. /yF V