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FOR OFFICE USE: ------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. ___.o�___� c3— -------------------- --------------------- (Complete in Duplicate) Date Issued This Permit Expires I 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, g / fat JOB ADDRESS AND LO ATION.�l l!/ llf�.f - / / " l �tue "�`►'t4 Owner's Name-- f-------/4+ ile_�--� -,e�---------- - Phone >`- " Address.----F 1� t aG.. h_ •_.... -- ------------------------------------•- ---------------•------------------------------------- ------------------------- ------•- Contractor's Name--------- t� Prone.. Installation will serve: Residence �' artment House ❑ Commercial ❑ Trailer Court [:1 Motel L] Other El � Number of living units: j___� Numb'er of bedrooms.;.-�� -______ Number of baths ____ Lot size . `.-----L ------------------------- I Water Supply: Public system E] Corom:unity system rivate E] Depth to Water Tabie0-.- f#. Character of soil to a depth of 3 feet.,Sond ❑ Gravel Q ea.Sandy Loam ❑, Clay Loam E] Clay ❑ Adobe I ardpan El Previous Application Made: (If yes,date-----------______-) Noi�New_Const:ruction:iYes-t No E&*"IFHANA: Yes ❑ 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 nearest well__ _--.�--Disfance from foundation---14----__;___4a�erial_.____ No. of compartments_-___ Size_ a Liquid depth__. ___ZZ_. ......._Capacity__.-_��-_____-_ "It ield: Distance from neaw -- ____-�-_Cis ? ._Distance from foundation___. ___.!._ _.Distance to nearest lot line___________ fSTe y Nu e er of lines materi -Length of each line_ _.____`"-__'_Width of french !� : I ------------------ d Type I-_.1--V2-----a-.Aepth of filter material-/4f __._ 5,tal length-------- -------------- - �� zr'� Seepage Pit: Distance to nearest we11---/_D -------Distance rom foundation____ G_____- Distance to nearest lot line____.-___._ ----Linin mfateiial �-3---------- P .-------- Number of:pits-_' g ---- Size: Diametert_ t Dept �")^ 1 Cesspool: Distance from nearest well________________]Distance from foundation___.________.__ _.Lining material------._____----------.-_-____-___._. Size: Diameter---- - -------------------------------Ce th-------------------------------------. ;�, L)'i uid Capacity Privy: Distance Distance from nearest well._.________..____ _--________________________Distancedr-11 ,- wJest building Y _____________..__..______- ❑ Distance to nearest lot line- ----- ----------- ------------------------------------------- � f------------------------------------------------------------ . - ---------------------- ..- --- - • Ing (describ - -- ------ --- - •--- - ---- - ------ - -- Remodel' and/or�tepalr { ------ -- - ---- ------------------ 6 --- 1 ----- ------ {- -------- -----•----------------- ---- ----- ----' -- �, ---------- ------- I r --------------------- ------------ I hereby certify that I have prepared this ap lica 'on an +hat the w4will be done i accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San _oaquin Local Health District. (Signed)-------------------------------------------------------------------------------------- ---- (Owner and/or Contractor) By------------------------------------------------------------------------ ------------------------- {Title)-------------- -------- -----..... -- ---- ------- (Plot plan, showing size of lot, location of system in relation to swells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY............... . ......... ..... - ---- ------- '------------------------------- DATE y� �� �• ., 4 REVIEWEDBY--------------------------------------------------------- ---------------------- ----- 1 DATE BUILDINGPERMIT ISSUED--------------------------------------------------------- 1--Z-------)------------------------- DATE--------------------------------------------- ----------- --- Alterationsand/or recommendations------------- -- - ---- -- ------------------ ----- ------------------------ ------------•-•----------------------------------------- ------------------ _ ------------------- ----- _ -----•------------------------------------- ---•-------------------------------------- ------------------------------------------------------------------------- ------------------ --------------------------- ------ - ---- ------ ------------ ------ ---------------------- ---------------------------- - - ---•------------------------ ------•--------------------�------------------ - -- ----------------------------- FINAL INSPECTION BY:--- ._ la. - -- -------- ----------•-------=------- Date_- � �-lbs ---- ---•-•--- ---------- -------- - ------------------------•---- `�' -'--SAN JOAQUIN LOCAL HEALTH DISTRICT'S 1661 E.Hazelton Ave. 300 West Oak Street } 124 Sycamore Street 205 West 9th Street 1 Stockton,California Lodi,California Manteca,California Tracy,California f� F.P.CO.