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ki ---------------FOR OFFICE USE: � t ------------ APPLICATION FOR SANITATION PERMIT Permit No. -._. - --- .- ..... --------------- ---- ----------- ------. _ . _ - {Complete in Duplicate) bate"Issued f�`�__!�� / ----------------------------------------------.------._-- � ,This Permit Expires 1 YearFrom„ u Date Iss ed .___,l___ 2-1 2—t 7 a•-ceb Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein descri Fr d. made-incompliance with County Ordinance N . 549. ;w JOB ADDRESS AND LOCATIO - --• --- --- -r '� -_ /_ ,�,��+ s ._ Owner's Nam`-=----w="-"-'----------- �� ---------------- Phone----------------------- Add ress .� Contractor's Name -----------------------------------------------------------------------------•---- Phone---•----•---------------•-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -___-_ Number of bedrooms 3--- Number of baths :'g_- Lot size --- _�. _.3 �___f_____________ E] q/ Water Supply: Public system Community system ❑ Private A"6epth to Water Table .Q---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dy Loam ❑ Clay Loa ❑ Clay ❑ Adobe Hardpan El Previous Application Made: (if yes,date........._---------I No New Construction: Yes [j�`NNo ❑ FHA/VA: Yes ❑ No�^Z C> TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic.tank or cesspool permitted if public sewer is available within NO feet may+„ � _ Septic Ta Distance from nearest well_____ ___Distance. rom foundation_f ___ _ � - ` y Material �� d' le No. of cam artments_..� _________________Size____ ' p _�_�"�.-�-----Liquid depth__---�-- -------- ---Capacity-' - - -------- s i - Disp sal Field: Distance from ne;a�re well-_��_!-_-.Distance from fou, at ion_l0__r___.___---Pistance to nearest lot line_=______�_____ Number of lines__�=------_________ ______ _Len th+of each lint-_;46,Q_._ _ �_� V�idth of trench____ __ `�._.___________-- g y Type of filter materialr1C_l[__ Depth.of filter material_� __`______.____Total length____; U___:___I_________________ S e e Pit: Distance to nearest'welL___________________'Distance from fou a ion__...___.-__.___._. istance to ne�rast lot line-------____-___.- �y11[� Number of pits------------ ------Lining material-----------------------Size: Diameter------_---------------_.Depth-----------------•--------.------ Cess ool: Distance from nearest well--------------___Distance from foundation_____.____________.Lining material___.__.-___________.____._-__-_______- ❑ Size: Diameter---------------------- ----- ---------Depth-------- ------------------------ -----------------Liquid Capacity----------------------------gals. -_ __ -�-� _ � �'• ,rt � .=•�"...p.>-- `"."�;.w '�_ ..,; rte.. #�--A'__-C-:�. _.-r--�,�. �°,,;:'�-�.-.- .r._ ,�� _ �. . y --------------------------- Distance-from nearest�buildin ------------------------------- El _.______ � Priv Distance from nearest.well__.._ _ _ -__-_ _____--.-- --__. ❑ Distance to nearest lot line----------------------------------- ------------------------------------------------------------------------------- -------------------- Remodeling and/or repairing (describe):--------- ------------------------------------------- -------------------------------------------------------------------------------=----------------------------------- --- ---------------------------- , ----------------------------------------------------- L ----------------------------------------------------------------------------------------------•--•------------------------..-----------------------------------------------••---------...------------------------------------ __________________________________.-.- -_________________________________-_____--____________-.--_----------____-___________________._________--__-•_-.---_-__-_-_--_______________.____-_ _•__.-____-___-y_y.._.____..______ b I hereby certify that I have prepared this ap ation a that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatio -the S Joaq ' Local Health District. (Signed) ______________(Owner and/or Contractor) BY:--------------•------------- --- ----------- ----- ----- - -----------------------------------------:�- (Title)---------------------------- ------ ------- - - - ----------- V- Piot fen `Showin 'size"of=lot,-loca o s stem -n reati&r 'w'ells, buildin s etc:can be-placed-onside):— ( P g_... Y 9 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ -------------------------------------t�--�-P-n/DATE____-- _--_- - � -- --------------------- f REVIEWED BY - ----------------- ----------------------------- ------------- DATE- BUILDINGPERMIT ISSUED-------------- ----------- ---------------------------- --- - ---------------------------------- DATE----------------------------------- Alterations and/or recommendations:------------------------------- -- --------- -----------------------------------•---------------•--------------------------------•------ ------------------- ----------•---•---•------------------•----------------- ------ --------------------------- ---------------------•------------------ ---------- -----------------------------------------------------------------•-•--- -------------------------- -------------------------------- -------------------------------------7----- --------------------------------------------- ---------- -- ------ ------ ----------- - ---------------------------------------------------------------- -----------------•---------. --------•----------------------- .....-- ------------------------------------------ ------------------------ FINAL INSPECTION BY------------------- -•------- �-+ .......-- --------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT } 1641 E.Maxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California — ' ES 9 REWSEG 8-59 3M 3-'63 F.P.CO. �