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FOR OFFICE USE: 1 F '---- ------- Permit No. ................. ; 3-.w-_-__- APPLICATION FOR SANITATION PERMIT �- ---------- ------ ---- --- ------- ---- ----- (Complete in Duplicate) Date Issue d ----- ----� ----- • __ This Permit Expires 1 Year From Date Issued ict for a permit to construct and install the work herein described. ., Application is hereby made to the San Joaquin Local Health Distr This application is made in compliance with County Ordinance No. 549. W1:0 S JOS ADDRESS ANDLOCATION----___ ___ d C� f 3 Z�oz� �� Owner's Name------------ --------- � /x"-s---- Phone--------------- ----•---•-•-------- -- --------------------- Address ' / ----------- ---- --- ----- - ---- ------------ Contractor's Name_ -- = _- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial [Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size --- - - r--------------------- Water Supply: Public system Er-c'mmunity system [IPrivate E] Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ 4 Previous Application Made: (If yes,date--------............I No �ew Construction: Yes ❑ No /.VA: Yes ❑ No R TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well-----------------Distance from foundation-------------------Mater ial--------------------------------.---------------- �J o. of compartments--------------------------Size--------------------------------Liquid depth------------ ------------Capacity---------------------- Disposal Field: Distance from nearest well_ ./._.__DistaRce�rom foundation_ �-./--Distance to nearest lot line___.._..._ Number of lines---------I-------- -- ---_ Length of each lire___._7:?11--�----------._.Width of french.___ ��----De th of filter material_. ._-�.---____Total length--______.. C ------------ Seepage --------- Z Type of filter material_�_,L�.___-___- p See�pa�g/e Pit: Distance to nearest well.__;' _C'-�-_Distance�f r foundation___- --- Distance to nearest lot lin dS--________ i 1rY Lining material ._ .._.-----._.Size: Diameter_ 3.. _.---.Depth_ _ Number of pits----�--- .. .____.�"_.--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- . F1 Size: Diameter------- ---------------- -- ----Depth----------- ------------------- = ------ Liquir� Capacity gals. 0 Privy: Distance from nearest well------- -----------------------------------------Distance from nearest building---------------------------------- - ❑ Distance to nearest lot line---------------------------- ----------------------------------- -------------------------------------------- �~ Remodeling and/or repairing (describe]__________________ - _ _ - - ----------- -- ------ ------------------------ -------------------------- ------------------ I ---------------------------------------------------------- ---------------------------- ------ - -------------------------- ---------- ---------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County o!- ordinances, ordinances, State laws, d rules and ions of the San Joaquin Local Health District. (Si ned (Owner and/or Contractor) 9 ) -------------- . . -- -- -- -- . Title - ------------------ ----- �Y= -- (Plot plan, showing size of to , anon of system in relation to wells, buildings, etc., can be placed on reverse si e. fN FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- - DATE----- � f�-------- ---------------- Z REVIEWED BY_ ------------------ DATE------------------------------------------------------------ ------------ -------------- ----- BUILDING PERMIT ISSUED ---------- ®DATE ,p Alterations and/or recommendations:---- /!% r�` o ----------------------------- ---------- --------------------------------------------------------------------- ------------------------ ---------------------------•- ------------ - ------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.. ----- -- --- - --- -- --- ---- Date-------- -------_------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.r_0.