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FOR OFFICE USE: rV * r s �p ' ,�------------fes- a Permit No. "m �; e- _"" APPLICATION FOR SANITATION PERMIT / �-�s--------------------- (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 compliance with County Ordinance No. 549. 1 ••- ------- £ -- -JOB ADDRESS AND LO N -- -'- ------------------------------------ Owner's Phone - ----------- Owner's Name--------- � ------- ! 4% -c ----------------------------------------- Address------------------------ _ ' Contractor's Name C� -------------- ----- Phone •------------ Installation will serve: ,ResidenceEr Apartment House [ICommercial E] Trailer Court ElMotel E] Other ❑ Number of living units: ____-- mber of bedrooms ____ umber ----- Lot size ------ -------------------- of baths y� Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Ll San oam E] Clay Loam ❑ y El Adobe Hardpan E]f r Previous Application Made: (if yes,date-_-.__--------------) No New Construction: Yes No F] FHA/VA: Yes-"❑ No f ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic n : Distance from nearest well----- from foundation_ -/.---.M serial-_ f.. No. of comparfiments------------��_Size-_-- ------� -- ; q --�/ �� ---------Capacity_ _ .��__Li uid de t ------- --- Distance to nearest let line__------- Disposal •eld: Distance from nearest well.._-_stance from"foundation___�f _Width of trench- - -------------------- Number of`lines � -r--_--- �"�"rLengfh of eacliline, � Type of filter r�iaterial-___ � ___s t pth of filte-e'rme er�ial__!---------Total length___ ---------------- 1 _ istance to nearest lot l�e _________ See a it: Distance to nearest ell-.___------ Distance m-f9pndation-_�____------ 3 p g (.4�-----Size: Diameter_�.---�J---------Depth�T,. -'Y Lining material" �? Number of pits-11.___ -- �. _ I Cesspool: Distance from nearest well--______-___.-_-Distance from foundation...._....._______..Lining material._-__"------------------------gals. -Liquid Capacity------------ ❑ Size: Diameter__.----------------------------- --.Depth----- -----'----- -- - ----'--------------------- g Privy: Distance from nearest well-------------------------------------------------- --------------------- from nearest building___-________-.__"________"__-._----_ - -. ,..r ---------- y ❑ Distance to nearest lot lire--____________________------------- -- Remodeling and/or repairing (descr'sbe):___________ ___ �', -------------------------------------------------------------- ---------------------------------- --------- f ------ - ----------- ---- ----------------- ---- ------------ ---- ---------------------- ------------------------------------- - -----------------------------------=--------------------------------------- ------- -------------------------------------- --- ' I hereby certify 1 have pre ared this application and that the work will be done in accordance with San Joaquin oun ordinances, State la rules n re ulations of the San Joaquin Local Health District, [Signed] -- ----------- ----------------------------- - --------(Owner and/or ContractorlIn (Title)._ -"--- [Plot plan, showing size of t, I at of system in relation to we Is, buildings, etc., can be place on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-------o---- -- - DATE___ "-" - T- REWEWED BY ------------ ------- ---------'- --------- ---'------- --------- ------------=-------------------------------- DATE-------- ---------------------------------------------- ' BUILDING PERMIT ISSUED------------------------------------ DATE---- - Alterations and/or recommend ations:77'- ------------- -_ +�_______________ _________ ____ _-"____ _ _ .-_---_______-.____--.-__.--______________-_-.________-____-_".__.__.__ ' G --- ' t ---- s- x-3� Z — FINAL INSPECTION BY:--- -- -- •------ ' ' -------- -- Date.-..L-_P:' - C ------------- -- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT r ' 1 205 West 9th Street " `15Q1;E'Haiellon Ave. 300'West•odk Street ,i 124 Sycorr ore'Streel C California Stockton,California Lodi,California Manteca,California Tracy, r F.P.CO.