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- F R OFFICE USE: ii II er_ =,-,-`____________ __ ___________.-____If--- APPLICATION FOR SANITATION PERMIT �'�' Permit No. _ ,(Complete in Duplicate)... --Date Issued ------------------------------------------------------ 'iii .. .: � ------------ --- .--------------------!-------- --- This Permit Expires 1 Year From 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. J08 ADDRESS AND LO ANION...-_j_ _.__/ t 9 c- -- ----------------------- Owner's Name--------- _ Phone ? -------------------- ------------------------------ - --------- ---------- --Hv_-__V, _ Address -+ _ ---— ------------------•-----------------------------------•------.-------•- Con#ractor's Name. - one--------------------------- ---- Installation will sere: Residence OK"Apartment HouseCommercial Trailer Court Motel Other Lj Number of living units____.�_ umber of bedrooms ❑ E]. Number of baths ________ Lot size __ __________________________________________________________ r Water Supply: Public system [ mmunity system ❑ Private ❑ Depth to Water Table -------- ft. ; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑�A- Previous Application Made: '[If yes,date........1-----------) No &-� New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from.I y undation__________________.Material_-____---___.________-------------------------- I I p No. of com artmentst-well��"_---.-.--_n setance from fo----------Liquid depth__________________------.:Capacity________-__-: ---____-- r t �� Number prom nearest well _ •__Distance from foundation. _(� __.Distance to nearest lot line��-___ • Dis sal Id: / Distance f lines_______________/{-' Length of each line Width of trench._ a_ -- - d Type.of filter material '_ _ Depth of,filter. material___,- Total length__'__ -( ___--- _-_ Seepage Pit: Distance to nearest well_._-1 ________Distance from foundation----------- Distance to nearest lot line------- .11 jk ❑ Number of pits-----------------A'Lining material------------------------Size: Diameter-.--_------------------Dept h---------------------_--- -------- s Cesspool: DiIstancei�from nearest well_'7-------------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------------------------------ ----------- Remodeling _._ __ -----------Remodelin9 and/or re airin9 (describe):_ _ 1l , , - _.__.-�_.._ _F_- - ____3_ y__ _--------------------------.____..-.__________.____-___._ .11 :k , '.. =------------•----------- --------- �� -- 1.:.� y - -------------------------------------------------------- i I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State haws, and, r les and"regulations of the San Joaquin Local Health,District. ` I l �� (Signed) '' -- - - -�- - - ------------------------ --------=-------------------------- -- � ------�---�-------(OW er and/or Contractor)- By: ontra R O BY: ----------------------------------------------------------------------------------(Title)------------------------------- c or j t (Plot plan, showing size of lotl location of.system in relation to wells, buildings,.etc.,.can.be placed on,reverse side). # j� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------- --------------------------- DATE---1 --�- �-� REVIEWEDBY ---------- ----------------------------- --- - ---- ------------------'------------------ DATE----- ! BUILDING PERMIT ISSUED__Ai--------------------------------------------------------•- ----- -- - ------ DATE----------------------------- Alterations and/or recommendations_______________ ______________________ _ ____.__v-- --------------------------------------------- _ ! -------- ------------------------------------- -- --- - ----- FINAL INSPECT N BY:-- f� r = " 4 D�,a�t+�e L9B�e - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California I E5 9 REV15E0 9.59 3M 3-'63 F.P�.Cq. '