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..FOR OFFICE USE: ------------------------------- ,. ------------------------ -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .,1. ._ ._... ------------------------------------------ -------------- (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`com_pliance'with County Ordinance No. 549. .� JOB ADDRESS AND LOCATION...:__.____-_2,-,-_.___-_--_ �L �Cd ..----•----•------ Owner's Name--------- -------------• r 4' c1111----------------:----- Phone---------------•-----------------•-- ------•-••-----------•- Contractor's Name----- ' `--re s- -------- -------------------------------------------------------- Phone--------------------_-----••-•--- . Installation will sdrve:.-Residence Apartment House ElCommercial ❑ Trailer Court E] Motel [I Other.❑ � Number of living units: __/_j Number of bedrooms Number of baths ...Z_ Lot size -------- "- a ,R,,>r -S, —� Water Supply: Public system .3 Community system ❑ Private ❑ Depth to Water Table ..t Character of soil to a depth of 3 feet. Sand E]- Gravel ❑ Sandy Loam ❑ Clay Loam Pg Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date`f-_.---_.- `. -_-) No„[- New Construction: Yes E] No E3 - FHA/VA: Yes E] No 6. k TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ti Distance from nearest well-----------------Distance from foundation_--__--___-------.Material -_._--___---_----__._-_-._.---_.._._-----____.No.-of compartments--------------------------Size----------------------------....Liquid depth_...-------------------•--Capacity----------------------- ' Disposal Ne l Distance from nearest well-----"�'"'._Distance from founclation..__.�:o.......Distance to nearest lot line-----�---- umber of lines---•--------------- --------------Length of each line-------l77d_---------Width of trench--------------�:-------'.._. Type of filter material-___ _Depth of filter material.__-`r�''_._.__..Total length_.__.___`------------------- �,\ r �A Seepa a Pit: Distance to nearest well---_--- J.-------Distance from foundation___ �3-.p Distance to nearest lot [in e----------------- Number !___-- : - Number of pits--.------_____/�,,-Lining.material_�.�.-_t�__�_��-Sizei"Diameter_�-_�__ ._.-.�` __Depth_--_' _____.�.. • ,, t yV Cesspool: Distance from nearest well_;___�__-_...�'Distance,from foundation_______ ___�'Ling materia).___--__----_____._.______._______._. I ❑ Size:'Diameter.___------------------------ ------Depth------ ------=--------------------------------------Liquid. Capacity gas. Privy: Distance from nearest:well---_-.-.___.__._----_--_~_ -__ -----.-:.-Distance from nearest building------_----------------------- l 19 ❑ Distance to nearest lot line------------------------- =------------------•-----------------•--------------------------------------•---------------------------------- Reling.-and/or repairing (describe) .......-_ ------------ - ------ -:--------- --- - V --------------- ------------ --------' -------- --- ----------------•--------------------------- ------ I herebycertify pthat I have re'pared this.applica iatfand that the work will be done in accordance with San Joaquin County ordinances, State laws, andrulesand regulations of the San.Joaquin Local Health District. (Signed) (Lr�T'•f -� ------ �` -------- -` - (Owner`and/or Contractor) By:----------------------------------- ------ --------"- --------------------------------------------------(Title)------------ , -------------- - --- (Plot -(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------- ----- --------------/L-y-------`------------------------------------------------ DATE----------- ��--------------- REVIEWEDBY----------------------------------------- -------------------------------------------------------------------- •-----------. DATE..-.------------ ----------------- �------------- BUILDINGPERMIT ISSUED---•----------- --=-----------------------•---------•---� -----•----- -----------;-------------_- DATE---------------------•- ------ Alterati s and/ r recommendations:------------------------ = -------•----------------- ----- -•---------•--•------- .----- -- - ---- ---•-- giS . �� = Tom"` :"_ oa� - �- -- - .---•- ``-�_ ------ - ---- ----- -------------------------- ' ------------- -----yi_ y /11 Z ----------- Y � - .' I / . FIN LIN ECT10N BY: � Date r------------------------- - JOAQUIN LOCAL HEALTH DISTRICT - I3 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lod[,California Manteca,California Tracy,California 4 E9•9 IQEO r.P.G O.�M fi•� � � / - - -