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FOR OFFICE USE: rNo. 1� II_--. APPLICATION FOR SANITATION PERMIT Permit ....................... ---- ------------------------------- ------------- ill_.__ (Complete in Duplicate) ------------ ------------- Date Issued --- - - ____�___" 41W 'This-Permit Expires I Year From Date'Issued R Application is hereby made .o the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in ompliance wifh County Ordinance No. 549t JOB ADDRESS AND OCATION = OIY� -r- Owner's Name.--- i i= Phone ----------- Contractor's Name_ = = t r one - :;---------------------- ------------------------------- me ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial [".Trailer Court, 1 Number of bedrooms _.�-- Number of baths . ._: Lot size �-- Number of living units: _ ._ _ Water Supply: Public system m �Commuriity system ❑ Private ❑ Depth to Water Tablet: Character of soil to a deptl# of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Q y Adobe Hardpan ❑ Previous Application Madel {If yes,dote_-_.___-_____--__-) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION ND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ? , �j ' Distan4>. from foundation---�!<____.------Materiaf__�_ e4o'-a- i-:---------- Septic Tank: Dis#an�5'from nearest we __--______ �' No. off�lomparfm-encs:---- -------------------Size.J_��- --------Liquid depth------ k_----------Capacity--•� Y_---.;- 1 ' Disposal Field: s 1Distanclle from neo" s ,well.__' '_____Distance from foundati�o/n___.�i�_:f.__.__Distance to nearest lot l e._ .________ Number of lines__:_ �Y__ __ ___. Length of each line_____�j_` Width_of trench__ __________________-- � - � 3--------. / ___---'----��----.Width-of � �' ------ Type 6T filter mater.iel__ "Gr��Depth of filter material_____ __.- ____Total length ; ___________________ _`-- See a e rt: *; DistalA to Z t well___w "'.__.__Distaal a fr~ dS ze nDi r, ale to nearest l ne_:_x Number of.pits---- Lining mater P, �� 0 P g -- i ] Cess ool: Distance from nearest well______________ _Distance from foundation------------------- imaterial______.____________--_______________. p i.. .q 1 ❑ Size: ameter------- {----------------------------Depth------------------------- --------- ----- Liquid Capacity-------•---------- gals. ` Distance from nearest buildin ' Privy: Distance.from nearest well---------------------------------------------- 9= -------------- ----------------- ❑ Distant to nearest lo# line } --= ------------------ ------ Remodeling and/or repai�ing,_(describe ;---------- e!t. ' , Ill,I -- - '� ; =-------------------------------------------------------------------- ..--------•--------•--------•-------•----------------- --- ----�� `---------------------------------. ---------------•-•------------ ---------------------------------------------- - 4 ---------------------------------__ _ _ 9_____------------------------------------------------- .______.____._______-__________.______-.________________.___________.__ -------------------.--------------- ..___- !'hereby certify that �F have prepared this application and that the work will'be done in accordance with San Joaquin County ordinances, State laws,' and''rules. and regulations.of theSan Joaquin Local Health District. r Contractor) ' -- - (Signed) - - - --------- sY� r ------------------(Title}-...... ^�1 '. (Plot plan, showing size of�Iot, Iota+ion of sys+ea ation to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY --- DATE-- 1_ I'S` ----------------------------- APPLICATION ACCEPTED BY____-C...... _ _____ --------- ----- ---- REVIEWEDBY----------------q1 =- S - -----...---------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------=-----------------------------------------—-------------------------------------- DATE----------------•--•-------------------- Alterations and/or recom'tl,end ations:------------.-------------- ---------------------------------------------------= ----__.••-----•-••-----------•----------------•--------•----------._.._------ -•-•------------------------------------- - -------------------------------=------ --------------------------------------•-------• ---------------- II ------•--------------•--••---------••----...----------•-------------------------------------- -- ----------- - ------------------------------- -----------------•----- ---------------- -----;--------------------•------ FINAL INSPECTION BY: Ct ` M -' Date------- t4 3 - �-- ----------------- ------------------------------ SAN,JOAQUIN LOCAL HEALTH DISTRICT .A 130 South American Street 900 West Oak Streets ,` 124 Sycamore Street 205 West 9th Street . e J Stockton,California I ' Lodi,California Manteca,California Tracy,California E8.9 PEV19EP 8.39 F.P.PO.aM 6.60-: