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FOR FILE USE: ------ APPLICATION FOR``SANITATION PERMIT Permit No. __� ` _ I Z ---------------------------------------------- (Complete in Duplicate) / This Permit Expires. 1 Year From Date Issued Date Issued ______ _______ ___h TM Application is hereby made to the San Joaquin Local Healfh Disfrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, LO ATO - -- -- i3'JOB ADDRESS AND ` ---------------- }_----- ----*------------_-_---_--- - Owner's Name-------- 4----- ---- Phone------------------------------------ Address------------------------ ----"---------•-•--••-"---"---•----Address------------------------ t} � ------- �-----CX)-- 1--r-10CL------------------------------------------------------------------ ....... ------------------- Contractor's Name_____________ ___ ........ `'" Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _tt _- Number of baths _ _____ Lot size --._-C3-.._..A--�-34--------------------- _1 ----------------- -- ; # M Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam ❑ Clay Loam [] Clay-❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote--------------------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) R ` Septic ank: Distance from nearest well-----—-------Distance from foundation___JG_`_----------.Material_-- �. ----- tel. Dispos Field: Distance from nearest well .____-----------Distance from foundation____ -6J--------Distance to nearest lot line----15'-!------ Number of lines------------ _i---_ _.._.._Length of each line------- of trench____'� _______._ Type of filler material---�_La,__ : epth of filter mater�al____jtt k_____.___Totaf length----1-14------------------------------- 12�'`M See Pit: Distance to nearest well------- l____._____Distance from foundation_____ i -----------Distance to nearest lot line----------------- Number of pits---- -----------------Lining material_----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material----------------------______________... ❑ Size: Diameter-__.___ ____________ _______Li Liquid. Capacity als. --- --- -------Depth----------- -- ----------------- - 9 _ p Y---------------------• ---• g I Privy: Distance from nearest well--------------------------------------------:____Distance from nearest busldin9-____.____._________.____,____-_--------. ❑ Distance to nearest lot line--------------------------------- ------------------------------•-•--------------- ---------------------------- Remodeling and/or repairing descrbe):--- ---- ----• -1-1--w- ?-.---- - - —----- ------------------------------•--------•----------------- } ,/1 ---------------------------------------------------------------------- ----------------------------------------- ------------------------------ I ------------------------------------------------------ -------------------------------------•------------------ -------------------------- ------------------------ ------------------------------- I hereby certify that I have prepared this epplicafian wnd"fhat-fhe work will"be done'.Hn accordance with San Joaquin C -��j ordinances, State 1 and rule d(regulations of the San Joaquin Local Health District, ou r i � 4 Signed( ). ---------(Owner and/or Contractor By:----------------------------- ---------------(Title ---(�'_ 'D ---------- (Plot plan, showing size of lot, Loc i�"ys;,Y-n- relation to wells, buildings, etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- -" DATE `' - .a- ---------------------------- REVIEWEDBY------------------------------------------- ------ ---"----------------------------------------------------- ------- --------- DATE--------------- ----------------------------------------- BUILDING PERMIT ISSUED--------------- - ------------------------------------------------------------------ DATE Alterations and/or recommendations: - ---------------------- -----------•-----------------------------•------------"-------------------------------------------------------- -----•--•-------------------- ------------------------------------ --------- - -------------------------------------------------------------------- ---------- -r--------------------------------- ----------------- ---------- FINAL INSPECTION BY: �-- -------- ------- '--- �- Date._s `-----------� -SAN JOAQUIN LOCAs. HEALTH..DISTRICT 1601 E.HaTallon Ave. 304 West Oak Street ' r .124•Sy?amore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f F.P.CO. F 4