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` FOR OFFICE USE: ------ --------- � '/S_:___� 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 a I' tion is made in com liance with Count _.Ordinance No. 549. 3�CU _ !+ S �•' JOB ADDRESS AND LOCATE,.r1 -_ -- - -- -- --/ � - c -: -- c ¢S � - - --- Owner's Name _.`.. �I �� " ---- ----------------------------------- ------------------------- Phone Address------------------ i Contractor's Name- ------------------ ---- - --• -• --------- --------------- Phone-------•----•-------•--- Installation will serve: Residence 0---A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a ' Number of living units. Number of.bedrooms _____Number of baths _ ___ Lot size _C5 - �2� ________________ / f- = I Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table6*_y ft. g Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe ,�, aarrd~p-an e P ❑ ❑ Y ❑ Y ❑ Y ❑ Il�� ❑ } Previous Application Made: (If yes,date--------------------} No Eirl<ew Construction: Yes [�---_1q_o HA/VA: Yes �5 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ri .(No septic tank or cesspool permitted if public sewer is available within 200 fee Septic Tank.' an Distance from" nearest well ___Distance from foundation-� ----__--__.Mate I._._- 4W Z5 i No. of com artments ----------Size__.3 Liquid dept ------ Capacity-- - - ___-- Dis osal f- Id: Distance from nearest well---621�_-.-_Distance from foundation__ _®_-(___--_-Distance to nearest lot P Number of lines------------- ._ Length of each line_____ _`� �/ I---)� g 7 -------Width oftrench----_��,-_•------------------ # Type of filter material____-1_-r__Q_Depth of filter material____- -- - �----------Total length-----------fid_ ___________________ R, Seepa it: Distance tf nes. .r_.e.st.iIwell--- - O� Distae m foundation__/A-(----.Distance to,nearest lot lint'_-__�- .-_ beoP - _ 5 mal --- --Size: Diameter_ : .`I -1Jepth:-c ------ ... Cesspool: Distance from neatest well-----------------Distance from foundation------------------- Lining material---. ----------------------------- u • ❑ Size: Diameter--------------------------------------Depth----------- ----------------------- ----------Li id Capacity---._....q.. -------•=-- --------'---gals. Privy: Distance from nearest well---------------------------------- from nearest buildin __ ------------------------------- ---------------------------- ------------------------------------ -------- ❑ Distance to nearest lot line------------------------------ -------- ------------------ ------ � �' Remodeling and/or re` airing [descei,b.e)____ ____ _ -- - --_ I l -_- - 7 " ---- -.e-_---- n� - - -�., _ ------- --- ------------- -- --- -------------------------------------- ------------- ---------------------------------------• ----------------------------------------------------------------------------•---=------------------ -------- ------ I hereby certifythat I hive prepared tliis appliiaafion end'fliat the work will be-done in accordance with San Joaquin County ordinances, Stat , and rules egulations of the San Joaquin Local Health District. n (Signed) = �; -------------------------------------------------------- (Owner and/or Contractor) c - ( ) --- -- ------------------ -- (Plot plan, showing iize of o�Iiocf�ion f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- L5%--f�,-------------------------------------------------------------------------- DATE----------- d r ` y=_6.-s ------------- REVIEWEDBY----- ------- ----------• --------------------------------------------- ------------------------- ------------------------- DATE BUILDINGPERMIT MUED--------------- -------------------------------------------------------------------------------------- DATE---- Alterations and/or recommendations:-- ---------------- --------------- 1�=�`----.r - . . --- - -------Q - ---- ------ � - ------- --- I ------------- - -- - ----- ------- ---------------------------------------------------------- -- -----`----------------------- -------------------------------- PI NAIL -----------------FINAL INSPECTION BY--------- --.............. _(jiDate ------------------ t SAN JOAQUIN LOCAL HEALTH DISTRICT y ' } f , -, f •0. f E� 1601 E.Ffoielton Ave'r�""""` 300 West Oak Street } e 124�sycamore street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California Int F.P.Cp. S':