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F . R OFFICE USE: ��B` l - - •-- APPLICATION FOR SANITATION PERMIT /D�5 ermit No.-------------- --------------------------------------------------- -- .____--_---- (Complete in Duplicate) 6o -d --------------------------------------------- F Date Issued __-f!__�,�--6•� .-.--____--_-__------------- ----------- ---------------- This permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and insfall the work herein described. This application is made in compliance with County OOrrdina e No. 549. JOB ADDRESS AND LOCATION --------- l Owner's Name �r------ Af------------ --------------------- Phone Address---------------- Contractor's Name ---.-. Phone. --------------------------------- Installation will serve: Residence [j--�Apartment House ❑ Commercial 'ag'I{railer Court ❑ Motel ❑ Other ❑ Number of living units: _ __._ Number c,f bedrooms J__ Number of baths -f,2- Lot size ----------..........____.-----.-------.__------_-.--.-.-_ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _93rOft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam E] Clay Loam ❑ Clay [j Adobe ardpan E]Previous Application Made: (If yes,date-............_--__.) No 1 New Construction: Yes ❑ No [A,"'FHA/VA: Yes ❑ No TYPE'OF INSTALLATION AND SPECIFICATIONS: N $ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ll� li, Senk: Distance from nearest well----------------- __ __ .. _-_-_----_Distance from foundation--------------- .Material-___.___--_----_------.-----___ -_-------__- pti �/ No. of compartments....----------------------Size-----------------l-------------Liquid depth--------------------------Capacity------- --------------- Dispos i '� Distance from nearest well. - Distance from foundation__/�?._----- Distance to nearest lot lin ----------- �.___ Number of iines---- ----------------------------Length of each line--3n.._-..__.y_.___-__.Width of trench_.a _ - _____-_--.___ _ Type of filter material im_k-_-.-_'Depth of filter maternal--,/k-______-_-.Total length......3_Cf_________________________ Seepage Pit: Distance to nearest well.a_ -----------Distance from fou dation-t1�_f_..__---Distance to nearest lot line_��_------- Number of pits...1-...............Lining material---J'-_ _ - ..Size: Diameter.- ._`r__..____Depth_ Cesspool: Dista �l-11._.`__------._-- Linin material------------------------------------- . , Distance from nearest weld__`":!.-______°`Distance from foundation;:_._ _ g El Size: Diameter------------------------------------Depth-------------------- 'Y�= ----------------Liquid Capality----------------------------gals. Privy: Distance from nearest well___.__ ____-._ _-----------------------�._--FDistance from nearest building_------------------------- ------------- ------------- .--..-_____.-------__- ________.._ ❑ Distance to nearest lot line.-.-.I---------�------- 0-------• -------------='--------------------------------- -------------------- ------- ----------------- - t r r f Remodeling and/or repairing (describe)=------------------------ :---------- --- ------------------------------- - -------- 0 ----------------- -------------------- -- ! /`-------------------------------------------------- -•---•------------------------------ ......_..�.,,,. s -. _,--� a i ---------------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County3 E ordinances, State lawAanru and regulations of the San Joaquin Local Health District. I {�r Con#ractor) (Signed)_ ------------------ By: ---- y --- ------ (Title)---------r----------- --- ------------ - -- ------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY--,--- -`------ ------ --- -- ----------------------------------- DATE-----`/ 1�--7.-- -G--------------------------- REVIEWEDBY---- - ---------------------- -- ---------------------------- -- DATE--- ------------------ ------------------- ---------------- BUILDINGPERMIT ISSUED-------------- ------------------- ---------------------------------------------- ------------------ DATE----------f.---•------------------------ ------------------- I Alterations and/or recommendations---------- ----------------- --------------------------------------------------------•-----------------------------------------•------------------- ------------- -------------------------------------------------------------------------- ------------------------ ------------------------------ -------- ---------------------------------------------------------------- --------------------- ------------------------------- i r - ------------------------------------------ ----------------- • ------ --------------- ---------------- - --- ------------------------- FINAL INSPECTION BY:7s__. -------- --------------- Date -1- $ -= ------------------ SAN JOAQUIN LOCAL. HEALTH DISTRICT } 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California IF,RCO.