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FOR OFFICE USE: t - ---- ---------------�f-_'_ __ -. -._-------------"----- ------ ---------- " APPLICATION FOR SANITATION PERMIT Permit No. . a Y6.... ------------------- -- ---------- ------3 3,"__ . (Complete in Duplicate) ---------- This Perrliit 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. 7.~ _JOB ADDRESS ANDALA?TIN -----� 5Owner's Name------------ ----- - - -- Y--•----- ---------------------...- •---- Address-----•------------------ /,040-4------------ --------- _ -------------------------------------------------------------- .............---------- Contractor's Name------ -- -- ----- ....... --------------- Installation -- Installation will"serve: Residence Apartment House ❑ Commercial ❑ Trailer Court' ❑ Motel ❑ Other ❑ Number of living units: _/--_._ Number of bedrooms _a;?_ Number of baths __/__ Lot size -_________________ Water Supply: Public system )( Commuriity system ❑ Private ❑ Depth to Water Table,5�_Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made:, (if yes,date_________________._) No New Construction: Yes ❑ NoX FHA``/.VA: Yes ❑ No ❑ 41� x f E TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic 'tank or cesspool permitted if public sewer is available within 200 feet.) *f �an Distance from nearest well-_____.__..._____Distance from fpundation__`_______________ Material-____.._____...____-__No. of compartments----- Size--------------------------------Liquid depth--------------•-----------Capacity----------------------- � ��`` f }.Distance from nearest well_ UX& Distance from foundation__/�___,�_Distance to nearest lot line_F5-________- 19 Number of lines---------/_______ _ _Length of each line__ _.�3�___Width.of french-------/2_�_____________`_ W/ Type of filter material-s/FC. Depth of filter mate ria I.- Total length------------------------ . _7S Seepage Pit: Distance to nearest ell . Diace foundation---- Oam :Distance to nearest lot line 15 __/__ "of p in material-- th -- - Cesspool: - Distance from nearest well-----------------Distance from foundation---.----------------Lining material-_-____________________________-_. N Size: Diameter------------- ------ ------.Depth---------------------------- ------ ---------------Liquid Capacity----------- ---- gals. 1 a Privy: Distance from nearest well ______-------------------------------------_---Distance from nearest building.__._..__.______._.__________.___.._-----. ❑ Distance to nearest lot line----- ---------- ----------------------------"•----------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------.i-:.---------------------------- --------------------------------------------------------- -------------------------------------------------------• --------------------------------------------------------------------------•------------------------------------------------------------------------------------------ ----------------------------------------------------- 9 { ---- ------------------------- ----------------------------------- --------•-------•----------------•----•----•--------.....------------------•---•--------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----- - ��; I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ro ordinances, a laws, and rule and ulations of the San aquin Local Health District. ' R (Signed)------ -- ----------- ---------------- - -- ----------- / - ------------------------------------------------------ (Owner and/or Contractor) By:-------------------- (Title) (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be place o reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I DATE , °?-"_' ' ' ------------------- ; REVIEWED BY------------------------------ --- ---------------------------------- -------------------------------------------- DATE------------------------------ ----------- ---------------- BUILDINGPERMIT ISSUED----------------- --------------------------------------•--------------------------------------------- DATE------------------------------------------------------------- Alteratio s an /or recom en ations- ----- --- ,- --- - - -- - -------------- ------------- -----•-------•------------------------------------------------------- .,, - � �- -------------------------------------- -------------- �. FINAL INSPECTION BY:.------..�. ---- ------ - -- --- --------------- Date `---��f--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California