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FOR OFFICE USE: P r ------------------ ------ I Permit No. APPLICATION FOR SANITATION PERMIT ----- --- --- -- (Complete in Duplicate) Date Issued ------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal;the work herein described. r j This application is made in compliance with County Ordinance No. 549. -------------------------------------------------------------- c� f +' JOB ADDRESS AND LOCATION---------------- ------------- ---------------------------- -------------------------------------- Owners Name---------1-/1,�1------------•!��• �--------------------------- - --- ------------- Address-------------------------- .a�> ''�`' ------------ t //� _.. '� / a/ .�'`- Phone_?"- _ _ _. r Contractor's Name_____________/7"--- a Installation will serve: -Residence IK Apartment House ❑ Commercial E] Trailer Court C1 Motel El Other ❑ Number,-of living units: --/-.-'Number of bedrooms --Y'- Number of baths __ ____ Lot size ----- Water Supply: Public i system ;K Community system ❑ Private ❑ Depth to Water Table a-ff ft. + Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ElClay Loam ElClay E] Adobe,a Hardpan ❑ cif N o '^ Previous Application Made: (If yes date___-_-------------) No X New Construction: Yes [I No �' FHA/VA: Yes ElA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a CSeptic Tank: , Distance from nearest well-----------------Distance from foundation___________________Material------------------------------------------------- rbV67No. of compartments-------- -----------------Size----------- --------------------Llquld depth-------------------------.Capacity------------ —`� E] "/S ,Y ! Disposal Field: Distance from nearest well--_4 "-.-Distance from foundation.--/Q'_ ------Distance to nearest lot line--�-------- f Number of lines-------1-------------------------Length of each line---------2.0 /-----.--Width of trench._._: --.------------------•-- t Type of filter material_/�f1 Cr - ----Depth of filter ma terial_.-f p-___......... _ --- -Total length_____s` 4'----•-------------------• I r -----.Distance to nearest lot line__'-�----- Seepage Pit: Distance to nearest well-./447----------Distance from foundation-_ Number of pits--- .l-_________Lining material__-/_P4_.��_.Size: Diameter_-_ - -- Depth------4— ---------------- Cesspool: Distance from ynearest well________________Distance from foundati -------------------- material ,------------- --- gals- 1771 ---.Depth--------------------------- --Liquid Capacity 9 Size: Diamete'r--------------_------------ -- Privy: Distance from nearest well--------------------------------------------- ---Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line_________________------------------------ - - -------- ---------•------'------ ------------------------------ r Remodeling and/or repairing Ede ribey:............. -- = �—'� J --------- .. • -------------- ------------------------ ---------------------------- Ir- e. - ------J0'=----- - f , I 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. (Owner and/or Contract I y Title----------- /1- ._...- By:- �, fla fel ' { } CP Plot Ian, showing size lot, location system in relation to walls, buildings, etc., can be placed on reverse side). { p g T l 1� j FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY f DATE-------Z��ir 1 REVIEWEDBY----- - ---------------------- ------- ---------------------------------------- --------------------------------------! DATE-------- ----------------------------------------------- BUILDING PERMIT ISSUED--------- -------- ------- DATE-------------------=--------------------------------------- `� - ------ ------ Alterations and/or recommendations:.__- -- - ' - ------------- ---------- ----------------------------------------------- - ----- --- --------------------- -------- ------------ ------------- ----------- ---------------•-------------------------------------------- ---------------------------- 1 ------•---- FINAL INSPECTION BY:----- .'._-_.... -` -- Date------ ---------- ..zi- ------------- --------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore St 1601 E.Hazelton Ave. 300 West Oak Street Street 205 West 9th Street Stockton,California Lodi,California. Manteca,California Tracy,California F.RCO. 1 _ _