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FOR OFFICE USE
<br />APPLICATION FOR SANITATION PERMIT Per-pit No........
<br />s.......:ti..,..
<br />(Complete in Duplicate) pate Issued ........ ;! ........t`
<br />�— This Permit Expires 1 Year From Data Issued
<br />APPlic,+tion is herebymade to the San Joaquin Local Health District for a permit to construct and install :he work herein described.
<br />This application is mde in compliance with County Ordinance No. 549,
<br />JOB ADDRESS AN +
<br />D LQ I ..........................................................................
<br />Owner's Name
<br />Plhone....................................
<br />Address........
<br />............. ......... ................
<br />...
<br />.....................................................................................
<br />COntracfcr's Name... ?,/.' Phone ...................................
<br />Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑
<br />NumFar of living un;ts:.. /.. Number of bedrooms .9- .. Number of baths -.. Lot size % `L i�...�.�if� r
<br />W"ter ;U,. t,•• rublic system ecommunity system ❑ Private ❑ Depth to Water Table %..�ft.
<br />Character of a depth of 3 feet: Send [j Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe aardpan ❑
<br />Previous Application Made: IIf ygs,date ) NO q3'� New Construction: Yes Q No gq-`FHA/VA: Yes ❑ Na [}.�
<br />TYPE OF INSTALLATION AND SPECIFICATIONS:
<br />(No septic tank or cesspool permi 'ed if public sewer is available within 200 feet,)
<br />SCept;c,Tank: Distance from nearest wall................ Distance from foundation ......... .......... Materiel....... _ ......................
<br />l� jf0'ri� No. of compartments.......................... S;:r................... ....... ..... Liquid depth' Capacity.... ...............
<br />DiS]o�al Feld: Uis+once from nearest well ....... .. Distance f-om foundation ........... ......Distance to nearest lot line .................
<br />Number of lines....- .. _...............Length of each line... _...................... Width of trench..,,,, ...........................
<br />Type of Filter material ........................Depth cf filter material..................... ..Total length, ............ ............ -....... ........
<br />.seepage Pit: Distance to nearest well.. . - ........Distance from foyndat;on....,.�.. Distance to nearest lot hne..- `..,...
<br />Number of pits..... 1...... ... Lining material-,XjP4 f—.. Size: Diametor..., 0."... _ Depth../ ..:..................
<br />Cesspool: Distance from nearest well.................Distance from foundation....,.........,.... Lining material .................................. ,.
<br />❑ Size: Diameter................ .................... Depth ...... :................ ...... --- ........ ...... Liquid Capacity ............................ gals. J .
<br />Privy: Distance from nearest wn1l...................,,........... ....Distance from nearest buildin
<br />❑
<br />Distance to nearest lot line -. ......... .....................
<br />............
<br />. 9,....
<br />...
<br />..._......,.:........_.........
<br />Remodeling end/or repairing (describe):.. .... .
<br />............................................................ -- ......................., , ........_.......... _........... ...........
<br />..............................................................................
<br />...............,....,........... ........... ........................................ ................... ,............... ............................................................................ ..
<br />...............,.. ..... ., . .................. .,.1... ........ ..I.............. ..
<br />I hereby certify that I have prepared this application and that fire work will be done In accordance with San Joaquin County
<br />ordinances, State laws, and
<br />rulcs and requii-tions of t e ,S/an Joaquin Local Health District,
<br />(Signed)...(Owner and/or Contractorl
<br />By: .......... .. ... ... ........... ... ........... ... .. ... .... . - - ... . ..... Til f 10)
<br />(Plot plan, showing size of lot, location of system in n to wells, buildings, etc., can be placed on reverse side),
<br />--- FOR DEPARWENT SE ONLY e
<br />4 dc
<br />APPLICATION ACCEPTED BY. �., , .... DATE...:-,�.!. -'cs.. . , ,.
<br />REVIEWEDBY .. _,.... ............... DATE......................................................
<br />BUILDINGPERMIT ISSUED..................... .. ......... _.......... __ ........_.... .............. DATE........
<br />Alterations and/or recommendafions: ..........
<br />ID
<br />\3 XXQZ o. 4 ' ... ,� ........... .
<br />FINAL INSPECTION BY:
<br />1601 1. Hacelton Ave
<br />Stockton, ceillfernia
<br />to a.9 -GID 6'99M.7 a3 rPcu
<br />Date .
<br />r'
<br />SAN JOAQUIN LOCAL HEALTH DISTRICT
<br />700 West Oak stnN 114 sytamoto Stnot 205 West Oth Seroei
<br />lacil, California Manteca, California fraty, California
<br />
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