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FOR OFFICE USE: ,ro --- ------- .l.. r [ � ___ --___._z,4" APPLICATION FOR SANITATION PERMIT Permit No. ... !.1�-__- }, a -------- ---- --- --------------------- -- ------------ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ..--_!_l. __ S 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 LO ON- _ -- _� ----- --- -- -• - Owner's Name t ? t — .1- -------------------------- --- Address--------------------- _ - e Contractor's Name f l Phone.4>> r' 7`�_. Installation will serve: Residence Apartment House ❑ Com .ercial E] Traiie Court ❑ Motel El Other ED Number of living units: J-_.- Number of bedroom_ umber of baths Lot size Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obeHardpan ❑ Previous Application Made: (If yes,date......... ..__ _._ } No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.) e tic Tcin Distance from nearesf well________________Distance from foundation--------------------Materia!_.._______-_..._____..___________________._____. No. of compartments----. --- J Size--------------- ---- -----------Liquid depth----------------- --------Capacity----------------------- o Distance from nearest well_ Distance from foundation____ �..r..Distance to nearest lot lin _____- - - _.__ Number of lines------ _. _ _Length of each line---:2..,5. ..It Width of trench_ - Type of filter materia; Depth of filter material �+..- -Total length-------- --------------, '" • ----__ Seop e Pit: Distance to neare wall_____ --- _-____ _Distant om oundation_� _____.Dist ce to nearest lot 1- f Number of pits- -.1 __Lining material__ . bC -.. Size: Diameter_ -------_ Depth_. _. - - Cesspool: Distance from nearest well-----------------Distance from foundation----------------- _ Lining material-------------------..---_-_-__-______ ❑ Size: Diameter- -- --- --------- -- ---------Depth--- --------- -- ...- ---------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well__________________________________________ ___ __Distance from nearest building.-.-_ -------------------------------- -- ❑ Distance to nearest lot line-- --- --------------------- - -------- ----- --- ------------------------------------------ 9 Remodeling and/or repairing (describe):--------- --- .__ ---_ ____ _________ ___ _ ------- ^ V, ---- -- -----•------ ----- ----------------- --- ---- - - - -- --- - -- ---- -- - -- --- -- - - ---- --- ------------------ ------------------------------------------- -------------------------------•------- -- -------------- ----- ------ -------------------------------- -------------- --------------------------------------------------- ------------------------------------------------------------------- ---------------------------------------------•------------------- ------------------------------------- ------------------------------- I hereby certify that I ha a prepared this application and th the work will be done in actor nce with San Joaquin County ordinances, State ws, and r es and re Mations of J uin Local He Distri t 1 (Signed)---- ------ --- ---- ntract ) - or BY:----------------------- ------------------------------------------------ Title)---------- ------ ------- ---- . ------ (Plot plan, showing size of lot, location of system in relation to I s, uildings, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--. -- ------------------------ DATE------ ---------- REVIEWED BY - - DATE------------/ BUILDING PERMIT ISSUED----------- -------"------------------------------------- ---------------- - DATE r Alterations and/or recommendations:.--- ,...mss_..'.-___ ------------------------------------------------------------- ------------------------------------------------ ---------------------------------------I------------------------------------------- --------- ---------- ........................... --------------------------- - -------------------------------------- ----- ------------------------------------ ----------- - ------------------------------ FINAL ------------- ------------- FINAL INSPECTION BY:- ----- - Date...... SAN JOAQUIN LOCAL HEALTH DISTRICT 1607 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California /�ryTracy,California /' F.P.CO. R J•` 030010if