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FOR OFFICE USE: a ---------------------- --------------=----------- �"•--rA. .. ? ---------------------------------------------- - - 'APPLICATION FOR SANITATION PERMIT Permit No. ?s� . 3 ------------• ------------ -----------�-------- -=------ {Complete in Duplicate) f 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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 49. „r JOB ADDRESS AND CATION--- � ta'C :=-------------- --:� _ , Owner's.Name_______ -• � -----.,_,., _----- -------Phone------- Address----------------------- _,_.,_Address----------------------- -----13 -- 4 - ----- -----------------------•--••------------------•--------------•- Contractor's Name i 'r----------------------------------------------------- Phone Installation will serve: Residence ❑ . Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units:--------- Number of bedrooms -------- Number of baths _____ Lot size __ _______________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tabledit. Character of soil to a depth of 3 feet: ;Sand ❑ Gravel ❑ Sandy Loam] Clay Loam ❑ C€ay ❑ Adobe❑ Hardpan I Previous Application Made: (If yes,date-----------_--------I No New Construction; Yes ` No ❑ FHA/VA: Yes E] No [ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) r" Septic Tank: Distance from nearestt ___well_ .: _'__Distan e.from fou ation__C/________ _______Yaferial_ --✓ _.___ No. of co`mpartments_____ .._`__Size_ }r _Y_Y. ,___Liquid depth___ ��._____.___._Capacifiy.___ Disposal Field: Distance from nearest well-._t 0.- Distance from foundation__ r0__7j-Distance to nearest lot line----- --- _ Xh Number of lines------f__________________._____Length of each line___ __7�0___.-Width of trench___.-z<LF_____. �: : f Type of fi1iter ma#erial _ ,e�i}f<'j'4_______Depth of filter material_-l�__________-Total length____ _.______________- Seepage Pit: Distance to nearest''Well ---- .____Distance .from foundation ,//.V---------Distance to nearest lot line_._._______._ Number-,off pits-_' /-.__.____ Lining material/ �L._.Size: Diameter' "_k:/,,"—__Depth-----IP---- 14 Cess ool: Distance ;from nearest well_________________Distance from foundation-----.--------------Lining material__._______.-___________._____-_-___. r - ❑ Size: Diameter------=-------------- ------- ----De th-------------------- --------------------- Li uid Capacity q. i Depth q P Y ---gals. Privy: Distance from nearest well----------------------------------------------._D.istance from nearest building------------------------------..____.____. ❑ Distance to nearest lot line------------------------------- Remodeling and/or repairing (describe= ,� ��` -- -•---- �r E t - -- --------- ---------------------------------- i i. ---------- ----------------------------------------- ---•---------------------------------------------------....--------- 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. (Signed)---- -- -------g---- ------- ------------------- ----------------------------------------------- (Owner and/or on ra - - _' - - (Title-- �.,.:.�,.�. c or (Plot plan, showi size of lot, location o�ys em in relation-to-wells,'buildings, etc'can be placed on reverse side]. FOR DEPARTMENT USE ON L APPLICATION ACCEPTED BY------ --•-- DATE__ . . REVIEWED BY ---------------- ----------------;------- -------------------------------------------------- DATE BUILDING PERMIT ISSUED---------------------------------------------------------- =-------------------------------------- .DA•TE----- Alterations and/or recommendations:__'----- ------ ---------------------- ------ ------------------I-------------------------11----------------------------------------------------------- ---------------------- ------------------ -------------------------I ------------------------ ------- ------------------------------------------- ------- --- -------------------------------------------- ------------------------- -------------------------------------• -------------- FINAL INSPECTION BY:... .- - -.� - - Date .r . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 4 Stockton,California # Lodi,California Manteca,California Tracy,California F.Ruo.