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FOR OFFICE USE: /p e r__________ APPLICATION FOR SANITATION PERMIT Permit No. ----------------------- ---------- ----------- - ------------ ----------------------------- (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 compliance with County Ordinance No.:549. JOB ADDRESS AN LOCATION-------�-=5- `�-/-- ---"" -------- �, /------- - -- -------------------- -------------------------------------------- - -----------------------------------•------- Owner's Name___ - - - - ------- Phone---------------------•-------------- t Address ----- ----- --- --------------------•--------------•---•--------------.----- 40 Contractor's Name------ ------- ------ Prone-f V/73 1--' Installation will serve: Residence F] Apartment House j_] Commercial ❑ Trailer Court [IMotel [Other ❑r Number of living units: :_- Number of bedrooms--.- Number of baths _,_X. Lot size ------------------ Water.Supply: Public system ❑ Community system [_1Private Depth to Water Table ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe V Hardpan ❑ Previo s Application Made: (If yes,d'ate-----------.---_---) No F1New Construction: Yes E] No FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptink:, Distance from nearest well----------------- from foundation________.__._------Material____.�_______________________________________- � " No. of compartments----------------• -------Size..----- ------------------Liquid depth-•-----------------------Capacity-•--------------------- " , Disposal Field: Distance from nearest well .__--_..-_D+stance from foundation___-,!d____._Distance to nearest Iqt line___S, _._._ _____Len th of each line______- �._._____-_.Width of trench____ .. ..............____.__ Number of lines------- _. -- -- ,f.. t Type of filter material__ �. Q_ Depth of filter material__ __ _________Total length---------.--------- ?____--.----- . Seepage �it: Distance to nearest welllQ_Q______ - ...Distance m fo ndation/__6--------- Distance to nearest lot Number of pits--]-./......_.---Lining material__ Q.-:�---Size: Diameter----_-�.----------Depth...__.c�s_________________ o� Cesspool: t Distance from nEarest well_________________Distance from foundation ------------------ Lining material--------------.----------.________-__. Y ❑ Size: Diameter...I------------------- --------------Depth------------------ --------------------------Liquid Capacity------------ -------------gals. Distance from nearest building --------- , Privy: Distance from nearest well----------------------------- g ❑ Distance to nearest lot line--------------------------------------------------------------------------------------=--------------------------------------------- INN I Remodeling,and/or repairing,(describe):------------- ------------ ----------------------------------------------•------------•------------------------------•-----•---=--------------- I --------- - -------------------------------------------=- --------------------------------------------------------------- ------------•---•---•----------•-----=-------•---------- ---------------------------•------------ -----•----------------------------------------------------------------------- ----- __ _--- 4 __ _ _-- ___________ _----------------------------_------------------------ -------------------._____.--------------------------------------------- ..___._-_ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, StAte law , .and rules and egulations of the San Joaquin Local Health District. j Sined ' ` -- -- ------ - --------------- ------ --- (Owner and/or Contractor] --(Title)- By: �' n} ----------- -- ------ -- r (Plot plan, showing sixe of lot, location�of system in relation to well , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY "f APPLICATION ACCEPTED BY------- ----------- -------------------- ----------- ------ DATE ----------------------- >>— REVIEWEDBY-------------------------------- -- - DATE_-------------------------------------------------------- .` BUILDING PERMIT ISSU'ED-- -----� s c --------------- - - ----- ,- - ATE---------------------------- - - - - -------- �1 . Alterations and/or recommendations:.---- �--:-,--;------------------------------------- -------•----------------------- --------•--- :.,- -- ---------------------------------------------------------------------- --------------------------- ,, - 9 --- .-----•-----------•--- ...__-__. ______________ ___s_ ' _------------------_------- ---------------_------__--______.___.._____-___ ___ ._ ____. ____ -_.____. .._______-_.._ > _______________________________________z___ F----__ ___.__. _---__...._.____............ - ____________________________________________________ 5 Y ' I FINAL..INSPECTION BY:------ .. �.� Dates = - --- ------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haielton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California . Tracy,California F.P.0 O.