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FOR OFFICE USE: -------------------------------------------- - U 'APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------------- (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 install the work herein described. This application is made in compliancewith County Ordina e No. 549. JOB ADDRESS AND LOC TION-----/ - -r- - - / Owner's Name----------- -- ------- - -------- --- ------ Phone---------------------------------- Address----------------------------- --- ---- ------- -- -------- --------•------ ---- = ` ------------------- Contractor's Name_______________ __ �yI'`° --- ---- - ----- ---------------------------------- Phone.------------- t Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court .I] Motel ❑ Other { Number of living units: __.�__ Number of bedrooms _S Number of baths __/_ Lot size __5D-------------________.______________'- Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table �U ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe [�Iarcip Previous Application Made:• Ilfyes,date_ .1_.41.4-___I No ❑ New Construction: Yes ❑ .No Lr FHA/VA: Yes ❑ N ". TYPE OF INSTALLATION AND SPECIFICATIONS:. (No;-septic tank or cess ool ermined if ublic sewer is available within 200 feet. { m Tank: Distance from nearest well_________________Distance from foundation____.____- Material___--_.._-__._..__._._.._________..____..____._. No. of compartments---------------------�--.Size-------------------------------Liquid depth-------------------------.Capacity------- ------ ------ Disposal ield: Distance from nearest well__�p.......Distance from foundation__,/.4_-_.____.Distance to nearest lot line_ _- t?1 E Number of lines------- -___ __-_Length of each line---�'� �_____-_,_ Width of trench------- ��______________ Type of filter materiaLs�__ t_!j� Depth of filter material-__, �..._____-Total "length___--_ +�_____ Se age Pit: Distance to nearest well-__._____-_________Distance from foundation--------------------Distance to nearest lot line__.__.________.._ Number of Its-----_ Linin material----------"-----------Size: Diameter---------------------.Depth-------------------------_------- P g Cesspool Distance from nearest well-----------------Distance from foundation----------------._..Lining material-______________.__._.____.___-___-- ❑ Size: Diameter------r ----- ---------------Depth----------------------------------"---- --- Liquid Capacity ----- gals ^- Privy: Distance from nearest well--------------.------ ---------------------------Distance from nearest building ____.__ ._ __._. oi ❑ Distance to nearest lot line -- - ---" - -------- -- ---- --------------------------- ----- --- � •------ " "------- - - i4 Remodeling and/or repairing {descri4� -e,}:_J._'�"_. _ _______ 1 y _ __.__.__ r __../_____________________.________-________________ _ ----------------------------------___________ ___.______________.-----------------.---------------.-----------------------------------------------------------.-------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,jS +e law , apd rules d reig lations of the SaizJ quip Local Health Dis#rict. (Signed)----- -------- ------ ------------ ----------`"" -- - - .(O ner and/or Contractor) ------7------------------• --•---- - - -_ ' _w--- . V=r_�------ ------[r+l�-- {Plot plan, showing size of lot, location of system in relation to welluildings, etc., can be ala ed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------- '' y ---------------------=------- DATE--.-2'- --------- ------- -------- REVIEWED BY-----------.._ = = ------ -"--------------------=:-- ----- DATE - ; BUILDING PERMIT I'SSU --------- ------ DATE------------------------------------------ - Alterations and/or recommendations:------ ----`----- ----- "-----------I------------------------------------------------------------------------------------------------------ ---------------- - ------------------------------ -------------------------------------------------------- ----------------- --------------------------------------------- ------------------ ----- ---------------- . ----------------------- -------------------------------- ----------------------------- FINAL INSPECTIO Y: ----------- Date-------------- --------------------------------------- SAN -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street —Stockton,California Lodi,California Mantecar California Tracy,California