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> R oFFICI= USE: &� YI 717 ----- i 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 Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 4 * r JOB ADDRESS A OCATION....... tf--------- f'f�--------------- Owner's Name--- .. ---- ------ Phone------------------------------------ Address------------ ------ .... lf? - --- Contractor's Name --t,,,,,.c- "y--- Phone. Installation will serve: Residence ❑ Apartment House ❑ Commercials Trailer Court ❑ Motel ❑ Other ❑ f : Number of living units: -------- Number of bedrooms'_.-_-__ .Number of baths ________ Lot size _____ . : � ' ��•. Water Supply: Public system Community system ❑ private ❑ Depth to Water Table -1-4 ft' ' Character of soil to a depth of feet: Sand ❑ ~ Gravel ❑ Sa dy Loam ❑ Clay Loam ❑ Clay �] Adobe f Hardpan ❑ ' \\ _ No Previous Applica+ion Made: (If yes,d•ate-------_---__. _ _-1 � ,❑New Construction: Yes No PHA/VA: Yes ❑ No ❑t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200.fee+.) b d ; Distance from nearest well________________Distance from foundation____._______.-.:.__.Material.__.______. ______..__._______________.______... Septic T�� No. of compartments------- ---------•--------Size--------------------------I---Liquid depth---'-`----------------------CapecitY------------------•---- Dlspoosal Field: Distance from nearest well------------------Distance from foundation.....---------------Distance to nearest lot line----------------- 6 ------------- 4J' # Number of lines--------------------------------- 'Length of each line----------------------------..Width of trench f :* Type of filter material-------------------------Depth of filter material-----------------------Total length----------------:----------------------- Seeps a-p•t:F Distance to nearest well__WOMeN----Distance f Dm fou dation__ Q_::'_.___..Dist n to riearest lot line_._-.- }� �� f . � -pi d Number of pits--- - --- Lining materia L___ ____- —C---C.Size: Diameter---___--- Depth------ ----•--------- Cesspool-'' Distance from nearest well----------------- from foundation--------------------Lining material ____.________.-____-________._______. \ ] Size: Diameter--------------------------- ----------Depth----------------------- ------------- ---=--------Liquid Capacity------------------• ---------gals . Privy: Distance from nearest well------------------------------------------------Distance from nearest,building------------------------------------------ 1 Distance to nearest lot line--------- -------------•--------•---------------------------------F� y - -------------- ---- k •'________••_____ _•_•__ ---- --------------- Remodeling ••-----------Remodeling and/or repairing (describe)• __ _- ------- _._-------.- Y ------------ --------------- f -------------------------------------- ------------ --- ---'--- -------------e' - --------- --•----- _ ---------------------------------- --- s a ._ _ _ - ---•------------------------------------ 41 4 lAereby cer+ify that l 9ave*prepared this a plication and that the work will be done in accordance with San Joaquin Count ordinances, Sfat an"d,rules and re 9sysfem the San Joaquin Local Health District. a _._ wed _ -- [Owner and/ Contractor)' {Signed} • � _ !, - +� By�!-----------------••=•------------ --- rtle} (Plot plan, showing size of lot, location of ells, buildings, ., can e placed on reverse side). ,., FOR DEPARTMENT USE ONLY ' DATE l if ------------- APPLICATION,ACCEPTED BY----- .._�_- � -c:----:-''---------- ------- ------ tREVIEWED BY------------------------_----• ------------ -----------------------:--------- ;----------------•----------------------- DATE------------------------------------------------------------ BUII_DING' PERMIT ISSUED----------- 1 -=-------------- --------------•-----------=`----•-----------------•---------------- DATE-------------------------------------------------------- Alterations and/or recommend a+ions:----------------------------- i ... - -� = - . ----------- INSPECTION BY:.. .`.� Date-.--- L� � "� ~ 6-(------ -------------------------------------- FINAL i. -- -- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E8.9 REVISED 8.59 F.F.Co,2M 6.60 4 F-