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FOR OFFICE USE: .� -- APPLICATION FOR SANITATION PERMIT Permit No. ..... l -------- -- --------- - - .----- , ---------------- (Comple#e in Duplicate) Date Issued _____ Z 6-� 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. pp e"with County O dinanc 549. This application is made ,n com IiancF� p� C-4---------- Owner's ___________Z ____ ._____._ JOB ADDRESS AND CAT N___.:_ ----- Owner's Name-------------- - -- ------ ------ --------------------- Address------------- ----Address---------------• -- ---- -- '� ` Phone_ ' Contractor's Name____ _ _ --:-- -------- ---- --- -#Ccmercial Installation will serve: Residence r Apartment House ❑ ❑ Trailer Court Motel Other ❑ ❑ -�------- -1 -------- - Number of living units: -/ -_ Number of bedrooms __Number of baths __._-__ Lot size _____ Private ❑ Depth to Water Table __..____ ft. Water Supply: Pub4ic system ommunity system ❑ Hardpan C]Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe❑ Previous Application Made: (if yes,date.-t-0 -!< No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) c Tan Distance from nearest well-________.--____Distance from foundation--------------------Materia ------------------ ---------------------- - No. of compartments--------------------------Size--------------------------------Liquid depth----------- --------------Capacity------ - -- D' sal Fi Distance from nt lot line earest well_ >t - Distance from foundati n• Wdthcofttrench e5 -------- A Length of each l --f- �` Number of lines-` -- g Total length------------------ int Type of filter materiai� - _Depth of filter matena!____.__��- --. stance to nearest lot line__._ i�T Distance to nearest well__ _ _ _____ ___-Distance from foundation_-____.____ ___.___. -__.Size: Diameter------ -------- ----Depth_.. ----------------------------- *age ^- Number of pits---------------------Lining material-------------------- I } i _ d ____ __-_...- _-.Lining material_ _ .___-.._.____. - -_------ --•- Cesspool: Distance from nearest well________________Distancerom _ Liquid Capacity.. ____..___gals. ❑ Size: Diameter:__1------=-------------- ---------- Depth----------------------------------------------------- 4 --•----------------- ------------------------- eDistance from nearest building_ _ -------------------------------- Distance -----------'------- --------- Distance from nearest well________________.._--____.. Privy: o 7 ❑ Distance to nearest lot line________________________________ ___• ------------------------------ - ft _- - ------------ Remodeling and/or repairing (describe):- ----------- --- e- -------- ---- ------ -------------------------------------------------------------------------------------------------------------------•------------------- - ---- - - - ---------- ----------- --- - -------- - -------- - - -- - - - ------------------------------------------------------------------------------------------------------ ----------------------- i I here- -by--- - --certify th-a----- -- f I have p-repare- - --d thi--- -- s a-pplication and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, ar�d,,rules and regulations of the San Auincal Health District. .__ f -- --------- ------ - �dw+telf,$r Contract Si ned - ---- SEPTIG TANK S= VfE g — 1Ti#Ie}BYMiner 5 =(Plot lansowing saeo fot, Ids;atori of system in relation tdin s, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE.---- �2_.-&-�----------------------- APPLICATION ACCEPTED BY- DATE--- -- ---------------------- -----=---- -----•---- ---- REVIEWED BY------------------------------- ---------- - --------- -- ------- • - - • -•---- --------� DATE-------- -------- - ----------------------- ---------- -- BUILDING PERMIT ISSUED------------------------------------- --- -------- ---------- -- ----- -- -------- Alterations and/or recommendations--------------------------------------------------------------------------------------------- - ----------------------------- --------------------------------- ------------------------ •--- 11 - --------------------------------------------------- - I ------- -- ------------- ----------------- ----- -- ---------------- ------------------ -------! �,�- Date ---- ------- --- ----- - FINAL INSPECTION BY--- ------------------- - -------------- -- - ---------- ------ -------- ---------- i t SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West oak Street 124 sycamore Street 205 West 9th Street 1601 E.Hazelton Ave. Trac California Stockton,California �.l Lodi,California � Manteca,California Y. i. - F.P.co. -