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��Ff�R OFFICE USE: � S _ --_--"- --------------------" -"-------- 5.s r .____ - APPLICATION, FOR SANITATION PERMIT Permit No. ...f12 ---------------------- -- --------_ -------- (Complete in Duplicate) . This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application-is ma � in compliance with County Ordinance No. 549. ` JOB^ADORE -S. ; LOC D ilf ATION. -a'�---------. lay '.$'- ?----W7�rc1-- , .- -I„E eo � `� Owners Name_ r ------ - ------------------ ---------- Phone3GK7-=---j�- Address----------- —---� � -----•--•- � i-----------•---------------------/--`----f------------------------- Contractor's Name- �-- �.1__t�:. ' Installation will serve: Residence UW- Apartment House ❑ Commercia ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -[--_-_ Number of bedrooms .0- Number of baths J_-._ Lot size -__---- -------------------- Water Supply: Public system ❑ Community system ❑ Private �pth to Water Table 60ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ AdobeJI'lHardpan ❑ - Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Distance from nearest well-----------------Distance from foundation--------------------Material---___--__.__---____-_--------------------.----_. No. of compartments- ----------- Size...---------------------- -----•Liquid depth---------- --- - ---------Capacity----------•------------ sal Distance from nearelt wyrlf _-�_Distance from foundailpn_�Q--�---Distance to nearest lot f�f Number of lines------ ---- -- --------- Length of each lined-� __ '� Width of trench_.• �� r �5414_ Type of filter matena�_- Depth of filter material-------�- -_-_..---Total length------------------- �_.--_.._-- ------- Seepage Pit: Distance to near e t well__,_'0Q-.-f Distant ro foundation-,_�1_-_.DlStanCe to nearest lot line- --- Number of pits-- ___---__.-_____Lining materialft--._ ..-__--_Size: Diameter--- 4-----Dept Distance from nearest well----.-____-_---Distance fr foundation--------------------Lining material__---__---___--_-----__---. ❑ Size: Diameter------------ -------------------------Depth----------------------------------------------------Liquid Capacity_-------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----.-------_--------_-----_----.--------. -, ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-- --------------- ------•--------- . ---•-••-------•---•------------------•----•---------------------------------------------- ----- f ---- ---t- - _ -. ---.- --------------------------------------------------------------------------------------•- ------------------------------------•------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e laws, and rules and regulations of the San J quin Local Health District. 1 (Signed) \ 1�- = try � �� 1 � Contractors --------------------------------- BY• -{Title) --------------------------------- ----- -- -------------- (Plot plan, showing size of lot, location of system in relation to wells, tidings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------------------- - -----------------------------------------�-5 _f-/ DATE-------- ��- � �� ------------------- REVIEWEDBY-------------------------------- ----------------------------------------------------------- ------------ --------------- DATE--------------------------------- - - BUILDING PERMIT ISSUED-------------------- -- DATE ----------....------------------------------- --------- Alterations and/or recommendations:---- r- ---------- ---------------------------------------------------•------------------------------------•------------------------------------------------------------------------------------ ------------------------------------- FINAL INSPECTION BY:. -- ----------------------- Date--------�z-�---f°------------- ----- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-5S 3M 3^'63 F.P.DD. f