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J /FR OFFICE USE: / p ----------------------_------------- ------------------- APPLICATION FOR `SANITATION-PERMIT Permit NO., .30, 7 --- - --------------- -------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date issued _____�� 5. - - J 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 County4Ordinance No. 549. JOB ADDRESS .AND LOCATION----' a p ��! ==�� Owner's Name a, - ---- . Phone � ^a--------------------- Address Z3 =_ - -- - ----- •- ` — , Address__.------•----•.... �/ ...... i Contractor's Name----- - BC ' - - Phone 7lr _r !`"id ' } Installation will serve: Residence merit House ❑ Commercial'[-] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/---- Number of bedrooms__ Number of baths __/--_ Lot size -----,/_6_�C._ _ �___________________ r e Water Supply: Public system �ommunity system ❑ Private El Depth.to Water Table �40 ft. Character of soil to a depth of 3 feet: Sand (] Gravel ❑ Sandy Loam F1 Clay Loam ❑ Clay [❑ Adobe �f4ardpan ❑ Previous Application Made: IIf yes,date__..___.-____..____) No 0----New Construction:'tiYes ❑ No ff�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I' tic nk: Distance from nearest well-----------------Distance from foundation------------------- Material---------------------------------------- e�ZNo. of compartments------ ----- -- _ ______Size______..______ Liquid depth----------- -- -----------Capacity I ield: Distance from nearest well---t'_.____._.:_.Distance from foundation.._._. -_____-___.Distance to nearest lot line---------------- f �' Number of lines-_'_}------------------------- ----Length of each line------------------------------Width of trench-------------:------------------•-- Type of filter material-------------------------Depth of filter material-----------------------Total length____________________________________- Q Seepage Pit: Distance to nearest well.-----Distanc m foundation__- O._.___.Distani� to nearest lot line-----S-------- Number of pits....;______________Lining material- Size: Diameter---- 4i__._.___.Depth_._._,? ................. Cesspool: Distance from nearest well___--------------Distance from foundation__________-________fining maa terial___.__..___________________________El . Size: Diameter------ ----------------i-------------.Depth----------------------------------- -----------------Liquid Capacity gals, Privy: Distance from nearest well__________________________________I-_________Distance from nearest building______._ ___-____-__________..___.---- ❑ Distance to nearest st lot line x. ; j j. Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ -------------------------------------------------------- ------------------------------- j. f' ---------------------------- ----------- ----------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, and rules and regulations of the San Joaquin Local Health District, r '° f/ (Signed) A - --------.(Owner and/or Contractor) ------- ---------------------- -- --- ---- - -------------- ----- BY ------------(Title}_._. '--- ------- --- ----------------- - (Plot plan, showing size of lot, location`.of system in relation to ells, buildings, etc., can be placed o9freverse side).' r ,l. FP -DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - - -----•- ---------------- =- _= ------' ----------------------- DATE---- C.J-------------------------------- ---- REVIEWED BY--------------------------------------------- ------ DATE---t------------Y BUILDING PERMIT ISSUED-------------- a----=`----------------------------------------------- DATE F- _ -- - Alterations and/or recommendations: �_.f�-� - __. .�..____�!----- .f ___________________ i, --------------------------------------------------------------- --------- -- ---------------------------- ---------•------------------------ ------------------------------•----------------------------------------------- 't -- ------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------•------------ -----•------------------- 1. 67- FINAL INSPECTION BY:---- . - -�-- ------_---- Da+e--.----- -1__-_.. ... - ---- ----------------- --------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O. `