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F R OFFICE USE: 1�,:, Q.___.__. APPLICATION FOR SANITATION PERM � _.Permit No. ..- ------ ------------------------------1`S-0.-____--- (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. -;: --- c r ADDRESS AND LO TION , � = ----------- = --------------------------------------------------- JOB .. -Phone------------------------------------ Owner s Name------------ , -- f Address--------- . �� Contractor's Name------- .,�y ---•---•------ ------- Phone---------------- ------------------ Installation will serve: esidence I Apartment HouseCommercial ❑ Trailer Court E] Motel ElOther�❑ Number of living units: -"->� umber of bedrooms ___... Number of baths --- Lot size -------�=--------------------------------------------- t Water Supply: Public system Community system ❑ Private E] Depth to Water Table _ ft.; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand barn ❑ Clay Loam [3 Clay ❑ cibe Hardpan ❑ Previous Application Made: (If yes,date---------..-...------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No 14/4 TYPE OF INSTALLATION AND SPECIFICATIONS: r' (No.septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well-----------------Distance from foundation------------------ Material .-_--.-----------.------------------__--------- r5 No. of compartrtlents---------- ----------Size--------------------- ---------Liquid deptkl -----Capacity--•-------------------- ".`_Distance from foundation..---/V_.-Distance to neares lot line.,�! Dispos laid: � Distance from nearest �"ell�. l- - _ . .. Number of lines-- --------L---j---------------Length of each line... ._�_.ZQ--- Width of trench .7-. --------- Type of filter material-17.Z---&VDepth of filter material....--j f__- f---___Total length__. ID Q. �,c i(l ,r " , T- Seepage Distance to nearest well_______..__a-__ ....Distanc •fjrom ,foundatiSiznDia ter: "Dist,�e to�ea}hst to lin _.. ___- �.�. �. I J Number of its..-. Liningmaterial--- -------- P o�2 I 0 p Cesspool: Distance from. nearest.weld---------------- Distance from foundation.-----------_-'----Lining-material------------- -------...."...__------ I w ,. ❑ Size: Diameter....I--..`..-"� �-rDepth= �:_:�..__�r,----•--- -------------- Liquid Capacity--- gals. Privy: Distance from nearest well------------------------------------------------ Distance from-near$s#=buifding----...-----------------------------------�/ ❑ Distance to nearest lot line-------------- ------------ ---------------------------------------------- ib 7 A Rem eling a / re iring (descre :-...... __ --- ---------- ----------- ------ ---- ------------- ------------------------- ry A7 t -----------------------------------------------------------I------------- --------------------------------------------------------- - J . I hereby certify that I h prepared this application and that the work will be done in accordance with San Joaquin County s ordinances, Stw , an ------------d le a�ddregulaflons of the San Joaquin Local Health Disfrict. ------.(Owner and/or Contractor) ------- (Signed)------ b ` -------- -------- - Title BY { } (Plot plan, showing size of lot tion of system in relafio wells, buildings, etc., can be pla don reverse side). •F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = - ---------------------------------- ----------- DATE-----JJ - ---------- ----- REVIEWEDBY------------------------------- -------- --------- -------- -------------------------- ------------------------------ DATE------ ------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------- ------------------ ------_--------- DATE--------------------------------- -------------------------- Alterations and/or recomme dations . -------- ----------------------------------•--•-----•-------•--------------------•-------------------------- �� - .t7 "- - . I�-- ------------------------- ---------------------------- -- ------ --- -- ------------------------------------------ --- ----------------------- ------------------------------------- FINAL INSPECTION BY:.------ C`�of� ----------------------- Date--- ��------- ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California A F.P.Cu. t