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FOR OFFICE USE: t --------------------------------------------=----------- APPLICATION FOR SANITATION PERMIT Permit No. _ ...:__... --------------------- -------- ----- ------------------- (Complete in Duplicate) ri }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 construe and install ##ie work herein described. This application is made in compliant' ith County Ordinance No, 549. 0 25 JOB ADDRESS AND jL CATION :7�`v- ---�`-"� Z--- ---------- ---------- ---------------------------------- Owner's -----�---- "-_�":==- lr�I � i Owner`s Name------------- -- .-- -------------------- ------------------------------------ ----------- -- -------------------..---- i r Address t Z �� --------- e._ ` .I v. Contractor's Name . .._•. -------•t-- --- - _.: _ Phone. _ ...• _ Installation will serge: `Residence lei Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑y Other ❑ �1 Number of living units: ----1__ Nof t __ Number of bedrooms _J Number he _.._ _ Lot �-size .-__.__ - - - --------- Water. Supply: Public:-system El Community system I] Private- Depth to ter Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_.-.--------------_.) No ❑ 'New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I u # I F (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) Septic Tank: Distance from- nearest well------------------Distance.❑ - � Materia-lt t ____ _________________________ No. of compartments--=----------------------Size------------------------------f Liquid ____ Capacity-------------.---` DispdDistance from nearest-well...�0fDistance from foundation_-_-/_&L _ Distanceline toy nearest lot lin`__r�_________ Number of lines-__�_---------�___________ __ Length of each line_______ 0-0.- Width of,,.trencsl '`�..- --------------- r Type of filter material____ �_ well .. f 'Distance.- Depth of filter material___.--._� ��_To#al length.=-_.-� f�___________________._ t; See a e Pit: Distance to nearest we _____________ stance rom Y p g foundation____________________Distance to riearest.lot line__._____._____._ ❑ Number of pits----,-'--------------Lining material-----------------------Size: Diamete,_.--} �Y-.----.Depth---- ----------------'-------._-�'. F Cesspool: Distance from nearest wel-------------------Distance from foundation--- --------- -----Lining material_____._____;____________.___-____-_-V, ❑ Size: Diameter----- -- - De th_.:------------- ---------_ :----� � ----- ---- ::==:--.. -r -a--.l.-s4- -�0--- ---------- uid Ca cit f _ .- � DePrivy: Distance.from neares#.well--------------- ------------------- - � istance-from„narest building ---------------- ❑ T !ot line._.._. _ - ' ------------------------------------- ---- --- Distance to nearest - ______________ - ••`''"�� . . f Remodeling and/or repairing (clescr;b :_'______________ - 4--------- . .:. 01 >. ------ ---- ---- T----- - 11 ---------------- , Ir fi , ------------------------------------i----•---------------------- :---------------------------------- ----------------•--------- ------------------------------- -----------------7T----------------------------------------------------------------------------------------------------------------------------- ---• •---_________________.,_____---_._______.______..___________----._-._.______________________________-_______________-_______________---.__________:_____________________________-_._----____________-_--_._________..__-_._-____._ 3 hereb6cert' at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, and rules and re tions of the San Joaquin Local Health District. dor Contractor Title �.—B - --- - ----•-- ---••---=--- -- - ------- ------- -------------------------------------------------- y ) (Plot plan, showing size of lot, location of sy em in rela ' n to wells, buildings, etc., can be.placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------- -- - -- -:--------- - ---------------------------------------- DATE---- ----------------------------- REVIEWED ---------------------------REVIEWED BY---------------------------------------------- ------------------------=-------- ---------------------------------------------- DATE------- -----------------------------------------=---------- BUILDINGPERMIT ISSUED--------=--------- I----------=----------------------------------------------------------------------- DATE------------------------------ ----------------------------- Alterationsand/or recommendations------------------------------------- - - ---------------•------------------------------------------•-•---------------- -------------------------------------- ---------- ---=----=-------=------------- -----------------------------------------------------------------------•----------------------------------------- -- -------------------------- ------------------------------------------------------- -----------_------------------------------ -----=-- ------------------------------------------. ------------------------- ---------------------------------- FINAL INSPECTION BY:.. ------------------- Date .-C� ... -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton 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.CG.