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F R OFFICE USE: - = T <;Q APPLICATION�FOR SANITATION PERMIT Permit No�.._.f .... - � -------- -------- (Complete in Duplicate)°-------- ---------------- --------- _-._-r___--------------_------___..._.._.. ; This Permit Expires 1 Year From Date issued 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 application is made in compliance. with County Ordinance No. 549. i JOB ADDRESS AND LOCATION_:'}I�f-�8 -------------------------------------------------------•---•----------------•---------------- ---- Owner's Name • .'1_-. --- Phone----------------------------- Address-----_----- -•--- . . _ ----- --------------------- � t hone_�1� Contractor's Name--- ------ --- - -- P --- --•- •--- --'- -----r---- --� -------------------------------------------- ------•---- ---------------- Installa+ion will serve: Residence j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ eNumber of living units: _/.... Number of bedrooms _2... Number of baths _L---- Lot size ----- -------_ Water_ Supply: Public system el_Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet. Sand E] Gravel E] Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe E Hardpan Previous:Application Made: (If yes,'date------------ --____.) No moi" New Construction: Yes ❑ No F• FHA/VA: Yes ElNom e TYPE OF INSTALLATION AND .SPECIFICATIONS: 1 i(No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! S�0'1", tic Tank: Distance from nearest well.................Distance from foundation--------.----------Materia------------------------------------------------ No. ...-----°......----.-.------------..--..------ No. of compartments-- ='-------------------Size----------------------------=---Liquid depth------------=-------------Capacity--------------------.--- Field: Distance from nearest well-)VQk`Q_.Distance from foundation....................Distance to nearest lot line....--.-..-._.._. ir Number of lines-,-.....f-------------------------Length of each line-..... ------------Width of trench...... ----------- ----------- Type of filter material... -.-..Depth of titer materia----PR.6�!K .Total, length..-g--- _XX-------------- ------------ See aae Pit: Distance to nearest well--tY-0 . ____Distance from foundation.....°----------Distance to nearest lot linea_S�-----__ �9 Number of ------------- rriaterial..Aaclk-------Size; Diameter---.-Wil.'`.:...__-Depth-.11�------------..-.-....._ p Cesspool: Distance from nearest well-----------------Distance from foundation............- --.Lining material-.....-..._.------------.-..-...._. " " -Li Liquid Capacity--------------------------gals. Size: Diameter---: _ Depth Q ❑ I -Distance from nearest building Privy: , Distance from nearest well 9 - ❑ Distance to nearest lot line- -------------- --------------- ----------- --•---------- ---- ---------------=-----:- ---------------------------- ---------- ` -------------------•--•--- { Remodeling and/or repairing (describe :-- 1 fi :. �, F j --------------------------- f G t : ordinances, State Las, and rules ....... .................. .-_._.. ------ ------------------------------------------------- - I`hereb certifythat I have prepared this application and that the work will be done in accordance-with San Joaquin County and regulations of the San Joaquin Local Health District. 4 (Signed) ~---------------------------------- ---(Owner a nd/or Contractor) - % � - - --- -- ----- - (Tette) .�----------- --- --------------- E . - system es, buildings, etc., can be placed on reverse s,de).(Plot ptanshowing size of lot, location of s s+em to relation to w By FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- � ---------------------------------- DATE---•--•-- `r ----------------------------- -- --- --------------------------------------- --- REVIEWED BY-------------------------- - - - -..._ -------------------- DATE -----..-------- -- -- - -- - ----------------------------------------------------- - kBUILDING PERMIT ISSUED---•--- --------------------------- ----- ---- ----- DATE----"------------------ ---------- -------------------------- Alterations -------------•------ ---- Alterations and/or recorn_ _ af'ons: ---- ----- 3 .. ------------------------------------ t --- ---- I FINAL INSPECTION BY:.._ ------;..._ --------�-- --- --------- " �..�t Da- 5_ = ' } SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 1 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy',California :] F.P.00. "'4 T�