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..FOR OFFICE USE: + - 7 ----------------------- ------------------------ APPLICATION AOR SANITATION PERMIT Permit No. ------------------------------------------- ----------- (Complete in Duplicate) . - bate Issued _-17 ------- ------------- ---------------------------- ------ This Permit Expires 1 Year From Date Issued L; Application is hereby made to the San Joaquin Local Health District for a permit to construct and`instali the work herein described. This application is made in compliance with County /Ordinance No. 549. JOB ADDRESS AND LOC TION.-J------- ------------------------------------------------------------------- Owner's Name------------ ------- -- - ---------------------1 -------------------------------------------------- ----------. Address------- 34' ?�d • -- -------------------------------------------------------- ------••-•----- - Contractor's Name-------- --------- -- -- ----- --- ---------• ---- -- _ Phone------ 4 ~'3��---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�1�_ Number of bedrooms __ _ Number of baths _cg_ Lot size __- ---_X__r _'------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table-,� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ , Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--pardpan ❑ Previous Application Made: [if yes,date....................) No New Construction: Yes ❑ No 21"FHA/VA: Yes ❑ No ❑ �? TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; ic• k; Distance from nearest well____-_'_-.------Distance from foundation--------------------Material___-______--__-._--_--._ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity...--- qD,; osal Fi d: Distance from nearest well_) . Distance from foundation. _. _____.Distance to nearest lot line_ ___._____ ®/ j Number of lines-1 ___fZ-___.___- _Length of each line______________ __ra____._.Wldth of,trench-_____ .____ Type of filter material__ _ . epth of Cfer' -material... -__.____--_Total length_-___________________�..1 ___--__- ~f r h Distance to nearest lot line_. _ .___ See a e #: Dis#ante to nearest well___--Distance m fT��1-�ndation___ _____________. A g f. ��.�j � t Number of pits--- __ _._________Lining material_ - ._Size: Diamefer.__. 3.__.._.____Depth------,�-� _____________- Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material-...__._---._...____.___--__-._______ ❑ Size: Diameter--- ------------------------------Depth------------------------- --- ------ ---------'---Liquid Capacity----------------------------gals. Privy; nearest well------------------------------------ - ---- -Distance from nearest building-_---.-------------------------------- -. ❑ Distance to nearest lot line-- ----- -----------------------=-- --------- ----------------------------------- I Remodelingand/or repairing (describe)---------- ----------------------- ----------------------------------------•---------------------•--------------•----------------------------------------- i t ,i -------- -----------------------------------------------------------------------------------•--------------------------------------------------------------------------------------•----•--------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws,,and ru] and r ulations of thelSa Joaquin.Local Health District. (Signed)__ �reerse and/or Contractor {- a By:---------------------------- . , .. ---------(Title) fed�!n (Plot plan, showing size of ot, location of system i elation to wells, buildings, etc., can be plde). } i FOR DEPARTMENTUSE ONLY i APPLICATION ACCEPTED BY-------- ' ------------ ------------------- -- ---------------------------------------- DATE--------';q- � ------------------------- REVIEWED BY......................................------- -- ----------------------- ----- ---------------------------------------- DATE__ 3 ---------------------------------------------------------- BUILDING PERMIT ISSUED E ----------------I---------:------------'-------- ------------- DATE------------------------------------------------------------- ; Alterationsand/or recommend ationss ------_---------------------------------------------------------------------------•---------------------------------------------------- F - 1 i -----• --------- --------------------------------------- ------------------------------------ - ------------------------------------------------------------------ ------- --------------- ----- ----- ---------------- - ---------------------------------------------- -------------- — r FINAL INSPECTION BY:--------.. f�...... . --- Date-- ----- ----------- ;--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Av*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. a- r I