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FOR OFFICE USE: T �I ---- ---- ---------------------L-------- ---------------- ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . ... ------------------- --- ----- i�1------------------------- (Complete in Duplicate) - -' This Permit Expires 1 Year From Date Issued Date Issued ...-...._r �_.._-. 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. 12—4,9.7-A �,,At t:c_rU6 JOB ADDRES�tANDtLOCATIO Owner's Name.----- :in 0 --- --------------------------------------- z Phon=e.i �---------- ------------------------- - - ----- -- --------------- Address-- r-3y -----------•-----------•------ ----O-----l-a----t•-~---f---2---c-�---�---a-- P Contractor's Name________ - _ �� o - - Installation will serve: Residence Apartment House E] Commercial L] Trailer Court ❑ Motel L] Other ❑ I, t Number of living units: ../-... Number of bedrooms _ .. Number aths .Y-- LO} size . , yFE -------------------------------_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- it, 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes date-----------.--------} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [ No seP tictank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: I` Distance from nearest well-----------------Distance from foundation------------------- Material-----_------------------------------- ..-..---- ❑ No. of compartments ---Size---------- --------------------Liquid depth-------------------------.Capacity----------------------- Disposal ' 1d:1 Distance from nearest well.,=.�g;F."__Distance from foundation----/0_"__.Distance to nearest lot line_A../.... --. Number of lines............../.... Length of each line--------2�7�..�._ :��__ -------.Width of trench----- --• - 1� t Type of filter material-------- -----Depth of filter material------�_ . ......Total length___._..1-0-f----------------------- Seepage Pit: Distance to nearest well....._.__............Distance from foundation....................Distance to nearest lot line ❑ I Number of pits---------------------Lining material--.--------------------Size: Diameter-----------------------Depth-----------------_----------- s Cesspool: Distance from nearest well-----------------Distance from foundation------------------ Lining material_-- --------------------------- .._. ❑ I Size: Diameter--------------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest'well----------------- -----------------.--------.....Distance from nearest building Distance to nearest lot Gne - I Remodeling ano/or repairing (describe)------------------------ -- .................... _-....._...._.-..__.___....-....- --------- --- --------------------------------------------------`------__-...------...----"..._---""..._..-..-._.-.----------------`� .........................'iy-... ...-----..............---------_ � --------- ...IL...}----------------------•.- ----------_. _ I hereby c fy that I have prepared this applicators and;that the work will be done in accordance with San Joaquin County ordinances, ate I s, and ruleWandlat, ons of the San Joaquin Local Health District. (Signed) - - ��-------- ----------- - ------------- ---------- --------------- [Owner and/or Contractor]------------------------------------------------------ Plot Ianr sh 21, r .- -- --------- ------ - -- --------------------------------------(Title)-------------------------------- ------ ----...-- ---:--------( p Eng size of lot, toyste in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION�ACCEPTED BY ---------'� _.� *f DATE....C '.'--Y' 'Ca j REVIEWEDBY-;---- -------------------------------------I--------------------- --------------------=------------------------------------- DATE----------------- ----------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ ---------------- DATE------------------------------------ ------------------ - -- - --- ---- ------------------- Alterations and/or recommendations----------- ------ - -- --------------------------------------------------------------------------------- ------------------------------------- ------------------------- ... it �) -------------------------- --------- - --------------•------------ ------------------------------------------------------ ----------------------------------- ----------------- ------------------------------------ -------------------------'M °------- ----------------- -------------------------------------------- ---------------------------------------------- --------------------------------------------------------------- - FINAL INSPECTION BY:,.,/, ---- - ^." r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.'Nozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ' F.P.r O. 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