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'FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ................ ,I _____ -------------------- _ [Complete in,Duplicate) � Date Issued ._�--r.�--�•�°- ------- ------p------ - This Permit Expires 1 Year From Date Issued _ A lication is hereby made to the San Joagiiin'Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County OrdinanceN . 549. t I Ph ..........--------- -------------------------------------- JOB ADDRESS AND LOC ION_.-- ------- ------------ ., .. -------- - one--------------------•---- Owners ame----- _'__.___- Address-------------- --•------ ----------------------------------------------•-----------------•--------- -------•--------------- - - Ph ------� � ---------- - one. Contractor's Name_-___ I ❑ Other Installation will serve: !Residence Apartment House ❑ Commercial ❑ Trailer Court M tel ❑ ❑ :I ----------------------------- tNumber of living units; _----I_ Number of bedrooms -:¢L.Llumber of baths _�.___ Lot •----`'J~6 Water Supply: Public:system ❑ Community system ❑ Private ❑ Depth to Water Table ft. ` Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe 1&1Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ Y V New Construction. Yes ❑ No [ FHA/VA: Yes ❑ No Previous Application Made: -(If yes,date-.---.----- ----) No 4 TYPE OF INSTALLATION AND SPECIFICATIONS: Nseptic tank or o Nocesspool permitted if public sewer is available within 200 feet.) Sep c T nk: Distance from nearest well_____-_______---Distance from foundatin_ de th Material_-------.,Capacity------------____ ---- /:No:�'of compartments------ ------------------Size--------------------------- Liquidf? f Disp s Field: istance from nearest well-----------------pe gth ofreach l rte foundation Width of}trench est lot line Number of lines: __--Total length--------—------=------------- -—---- -------- --- Type of filter material_____________:-----------Depth of filter material-___.___---:--__-: - to nearest well___ 1- - Distant m foundation___/0��--.----- •stance to nearest lot line__ ------ 4 Distance } -- - ----Depth------ -- 2—y-2-- Num —y- --- r I See Number of pits..---------1--- ------Lining material---/ [�_ __ size: Diameter___-_ - g f Cesspool: Distance from4nearest,well_________________Distance from•foundation----_.____.._____..Lining material_______._-----`--"--------`----- l ;-.Liquid Capacity gals. ft'l Size: Diameter-°----•------- --------- --- --- --Depth-----------------------•---------------- F Distance Jrom nearest building_________________________________________ Privy: Distance from.nearest well-----:------- ----------------- -------------- ❑ ---------------------- --------- Distance to nearest of ine----------------------- --- l ------------------------------------------ ------------------------------------------ �f Remodeling and/or repairing (describe :____________________ It------------------------------------------------•------------------------------=---------------------=---------------------------- ------------------ ---- ---- ----------------------- ----- --------------------------------------------------•-------.-t-----.------------ -;- -----:-------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and tha# the work will be done in accordance with San Joaquin County ordinances. State laws, and.rules and regulations of the n Joaquin Local Health District. [O(Owner r Contract and/or _ { i ------------------------------------ (Signed)By----------------------- ----------- --- -------------- , {Title} g _ I [Plot plan, showing size of lot, location of s ern in relatt n to wells, building s, etc., can.be placed on reverse side). FOR DEPARTMENT USE ONLY __ ____________________I--._______ __ ------------ DATE Z-' 's' --------------------------- l;+ APPLICATION ACCEPTED BY - DATE--- -------------- :: .;,REVIEWED BY - ---------------------------------------------------- . BUILDING PERMIT ISSUED--------------------------------- : -- - - Alterations and/or recommendations-----------------------------------_----------------------------- ------------------ ------------------- - ,. F l --------------------------- --------------- ----------------- -------- ------------------- - - -- ----------- -- -------------- RNAL INSPECTION By------ --- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT t Oak street 124 sycamore Street 205 West 9th Street 1601 e.Hazelton Ave. 300 Wes Lodi,California Manteca,California Tracy,California j Stockton,California F Fs 9 R�VIS ED Fi-69 3M 3-'63 F.F�.CC.