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FOR OFFICE USE- ------------------ ---------------------------------- Permit No. ------------------------=-------------------------------- APPLICATION FOR SANITATION PERMIT ,l ---------- ------------- ---------- - . (Complete n p ., ----- ---- - CiDuplicate) r _ .....:- -.. ., Date Issued ---�---�To -•�� --------------- -------------.-___--..-----.____._--..___ This Permit Expires 1 Year From Date Issued Application is hereby made to'the.San Joaquin Local Health District for a permit to construct mall the work herein described. This application is made in compliance with County Ordinance No. 549. : r JOB ADDRESS AND LOCATION C17 -- '- . -: Owner's Name------ _. 7. - --- Phone = I Address----•-------------- ------- �` d b-•.--------------------------------------------------•- ------------------------------------ ---------- Contractor's Name E ------ Phone. --------•• -•----•-------------- Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: _./____.- Number ofbedrooms __��____ Number OfbathsAi__ Lot size ___ -------------------- -- I Water Supply: Public system Community'system ❑" Private ❑ Depth to Water Table A.-0- ft. ; Character of soil to a depth of 3 feet:4 Sand ❑ Gravel ❑ Sandy Loamt Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date.................._1 No New Construction: Yes J?G No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted-if 1publiic sewer is available within 200 feet.).- Mat eet.), - �. ..- �- - �" Setic Tank: Distance from nearest well__ _.d __.__Distanced from foundation___ --------------- No. b_____ _.Mat�riaL___ ________________________-------------------- _p No. of compartments----------------- -- Size__ ----gt_-s-------Liquid depth--------------------------Ca pacify- --U"fl------ i Disposal Field: Distance from nearest weILJ�Q-------Distance from foundation__/d_________.Distance to nearest lot line__ __ --------- tj 0 Number of lines_____ -•______________---____---Length of each line____�9----__-_______._-Width of trench__ �i�l"k?,_��_______.____ Type of.fiiter materiae_# -Depth of filter material----,C.9-------------Total length-14-0------------------------------- . . Ill.Seepage Pit: Distance to nearest well----------------------Distan'ce from foundation-------------------Distance to nearest lot line---------------_ ❑ Number of pits----------------------Lining material---------_-------------Size: Diameter----•------------------.Depth----------------------- ---------- Cesspool: Distance from nearest well------------------Distance from foundation---._______.__-__- Lining material__ _----------_----------- ______ ❑ Size: Diameter---------------------------- ---------Depth------------- -'--- --------Liquid Capacity --- gals, Privy: Distance from nearest well--------------- _------------------.--------------Distance from nearest building-----.------------------------- --------- ' ❑ Distance to nearest lot line----------------------------------------------- ------------------------------------•------------------------------------------------------- • t m Remodeling and/or :repairing (describe)------------------------ ------------------- --------------------------•------------ ------------------------------• --------------- ----------- ------ ------------ � -----------------------------------° --------------------------------------- ----- l---------------------------------------------------------------------------- ---- --------------------------------- ---- --------------------------------------------------------•------------------•------------------------------------------------••----------- x - I hereby certify thjf,:l.have prepared his application and that the work will be done in accordance with San Joaquin County ordinances, law %andliules and reg {ations the:San Joaquin Local Health District. } {Sign ' -:4� ---------- -----------------------------------------------------------------------(Owner and/or Contractor) -------- ------------------- -- BY:------------------------------------------------------ ------------------------------------- ----------r--------- -------------- -------------------------=------ ------(Title)---------------------------------------- - ----------------- - - (Plot_plan-,_showing,size_ofrlofJocatioh' f,.system'in:-relation_to=wells='buildings,=etc. can-be-placed-on-reverseTsid ). FOR DEPARTMENT USE ONLY TE APPLICATION ACCEPTED ---------------------------------------------------- DA - REVIEWED BY------------------------ ------------------------------ - DATE BUILDINGPERMIT ISSUED------------- - --------------- DATE.---- ------------------------------------------------------- Alterations and/or recommendations------------ ----•------ -- ------------------------------------------------------------------------------------------------------------- a t ------------------------- ---------------------------------- --- --------------------------------------------------------------------------------------------- -------------------------------- -•---------- ----------------------------------------------------------------------- -----=---------- - - - �•• FINAL INSPECTION BY• ----- ------------- Date._-----�- ;0 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ' Ea 9 REVISED 95.59 3M 3-'63 i.P.CG. •""` %.{, --