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FO �OFFI U: 1 4 ------`- 7�- �i APPLICATION FOR SANITATION PERMIT Permit No. , _o - �------ -- tp ----- /j,_-¢___. (Complete in Duplica+el Date Issued This Permit Expires i Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permif to construct and install the work herein described. ; This application is made in compliance with County O inance No. 549. CCf� GG JOB ADDRESS AND LOCATI 9f F,2 ----------------------------------------------------------------------------------------------------- Owner's Name-----// - ------------------ ----- Phone------------------------------------ . .....----•-••-•---•----•--- Address-------------ZA4_ ----------------_------------------ --------------------•--•-----••------------------------------------------•-•. Contractor's Name.--- .. -------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court C] Motel ❑ Other ❑ INumber of living units: ___/__ Number of bedrooms, Number of baths ... Lot size ____-gax..1-4k----_-------_------------- r. Water Supply: Public system 111--tommunity system ❑ Private ❑ Depth to Water Table(_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ I Previous Application Made: (if yes,date____________________) No New Construction: Yes [ 10 ❑ FHA/VA: Yes C] No, f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank or cesspool permitted if public sewer is available within 200 feet.) SFpti Tank: Distance from nearest well_________________Distance from foundation------------........Material-------------------------------------- .. No. of compartments--------------- •---------Size------------------------------•-Liquid depth--------------------------Capacity---............ ••---• atleo Disp l F#el Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. Number of lines-----------------------------------Length of each line-----•-----•---------------. .Width of trench-----•-----------------•----------- Type of filter material_-•--------------------Dept6�"._ r,m rial-----------------------Total length__.....----•--••---•---------•---------•- Seepag t: Distance to nearest well_ ---Dista fo da ion___�_n�____........Distancce to nearest lot line..i3`_•_____- Number of pits_-----_=I-----------Lining materi -- ----- ze: Diameterz'___4 ---------_.Depth.-•------ .-----•---.:.__ Cesspool: Distance from nearest well_________________Distafoundation__.__--__-___.._.__.Lining material.._.__.._..._____.-_____....-___...._ als F1Size: Diameter---- --------------------- -----------Depth---------------------------- -----------------•-----Liquid Capacity------------------------ g . Privy: Distance from nearest well-__________________________________._-. -------Distance from nearest building------------------------------------------ Distance to nearest lot line------------------------------------------------ ••------------------------------------------------------- I Remodeling and/or repairing (describe):----------------------------------------- -------••-------•••-•---------•---•-----•--------•--••------...------••-•----•----....... I --------------------------------------------------------------------------------------- ---------------•----------------------------------- •I-------------------------------------- --------•------------•----------•------------------------------------- -••---------------------•---------•-------- •---------•----------------------------------------------••------------------------------------------•-------------•-------•------------------------•-----....-_.-------------------•--------------------•-•-------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation f the n Joaquin Local Health District. (Signed) (Owner and/or Contractor) By:-----...---•-••-•••--- -(Title).. . --- -- -- ------------ (Plot plan, showing size of lot, loca 0 $ +em in rela+io to wells, buildings, etc., can be placed on reverse side). FOR DEPAR E USE ONLY APPLICATION ACCEPTED BY---------- --- - ----- DATE--------- -.. .__---- ----- ___..------------------ REVIEWEDBY----------------------------------- ---------- --- --- - DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------------------------- -------------•------------------------------------------ DATE----------------- --------•- 41 Alterations and/or recommendations:___` �•- FINAL INSPECTION BY:_ ___.-- .�= Date------- ------ Z � ��--w-�------•----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sire-t 300 West Oak Slreet 124 Sycamore Street 205 west 9th street Stockton,California Lodi,California Manteca,California Tracy,California E9 51 REVISED 8.59 2M 5-61 At LAS