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FOR OFFICE USE: •�� ------------------------------------------------------ 37 ---- ------------------------------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. .._�.. ..:j .-- ------------ ------------- (Complete in Duplicate) --------------------------------------__.____.__-.._.- This Permit Expires 1 Year From Date Issued Date Issued .............f__�_.. 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. 0c-q 240 32--. 7 fP 3e ,e0 JOB ADDRESS AND CATI N_._,t!Y�- � dPC' .. . . '--- � Pr. Owner's Name....------ --------------------------------------------- Phone---------------•----------------- ------------•---------------=---•------••---•----------•-----•-•--•-•------•-----------------•-•-•••......--- Contractor's Name......- ,/� ...---------• Phane.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms .--?- Number of baths .2--'.. Lot size .................................... Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table jOQ ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑- Clay Loam_QQ.:Clay ❑. _Adobe..Be_'_'Pardpan ❑- Previous Application Made: .(If yes,date---------------- ---) No 20' New Construction: Yes ga-�'fVo ❑ FHA/VA. Yes 93-' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well 4.A7 Distance from foundation----,��.---------material__1&-_er. ��'/. ................... No. of compartments_._. __ _____ Sixe �l.�MZ'k4WAIquid-depth._. _---_-__--____Capacity.,l 4 __.:.,. Disposal Field: Distance from nearest well._.io;�-- _.._Distance from foundatjo®s. P____------Distance to nearest Iot`ine�............: [�' Number of lines..______'___ _____________ _Length of each line__ ._-._____-__pphi____ Width of trench../---___._..._._-__.____...-. -- Type of filter material.�_"TXDepth of filter material __________Total length... ..................____or _..__ Seepage Pit: Distance to nearest well---/,��-------Distance from foundation_- __-'Distance to nearest lot line--- ®..____• t� Number of pits----;Z____---------Lining material_® �--Size: Diameter.. ____Depth___a Cesspool: Distance from nearest well----------------_Distance from foundation_-:%'______..•__._.Lining material..._________--_.--_____--_--_•--____. ❑ Size: Diameter--------------------------------------Depth-------- -------- - •- qCapacity--••--••---------------- -9als. Privy: Distance from nearest well-----------------------I-_-- --------------------Distance-from nearest building-_____________...___.___•_•__-_--______ ❑ Distance to nearest lot line------------------------- ._- ---- ' { Zh' Remodeling and/or repairing (describe):____---f___� •--- - ....+. •---------------••------------ Sl r ------•-----------•----------------------------------•-----•--- ----------------•---------------------...------------------•-•--------------•---•-•------.....-.----•--------•-----•-•----•-------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules andZ1ru/, ations of the San Joaquin Local Health District: -(Signed) _ ,:.. � - (Qirrafl�or Contractor]: - ----- = � j B •-� {Title)__ �/,� ,f -- r•-------------------------------------------------------------- -- (Plot plan, showing size of lot, location of sy irrrelatio►l +o wells,-buildings,•etc., can be.placed on reverse side). FOR.DEPARTMENT USE ONLY iy APPLICATION ACCEPTED BY--- ---•------------------------------ ----------------------•-- --------- DATE-------- '. .-...-------------------- REVIEWEDBY-------------------•--...--------------------- •--------------------• ------ ----------------- DATE-------------------....------------•---- ------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------•-•----------------------------------------- Alterationsand/or recommendations:------------------------------ ------------------------------------------------------------•----•-••-•-----•-•--....................----.-----•---------.-_-- -------•----------•-----------------•-••-------. -- --------------•------------------•---------•---•----------------...-.--•--._------•--•-----•-•-•----.__-.------_-._---•-----------------------... ...........................•--...._..------. ••---....-•----_-----•-----------------------------•----------- ---------------------••--------•-•--------......------------------...-----•---------------------•-•-------••----- FINAL INSPECTION BY:.. Date----- ------------ ------------------------------------ - SAN JOAQUIN LOCAL HEALTH.DISTRICT 130 South American Street 300'West Oak streeti 124 Sycamore 51nof 205 West 9th Street Stockton,California Lodi,California Manteca,Californiay ' Tracy,California ES'9 REVISED 0.69 2M 5•61 At LAS