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FO OFFICE,.US ---------------_-- __--___-_-___-______-___-__1----- ------------------------------------------------ ---- APPLICATION FOR SANITATION PERMIT Permit No. -- 1!---- -------------------------------------------- ------- - - ------------------------------- --------- 1 This Permit Expires res 1 Year Duplicate) Date Issued Date Issued _____ Application is hereby made" o the San Joaquin Local Health trict a permit to constru d install the work herein described. This application is made i c mpliance w County Ordinan No. ' J013ADDRESS AN �N_ __.....-•----------- ----- -- --•®-�---- -• •----•--- -----._-..------ .......•----- -----•---•• -•-------- ------------- ---y' •------- -- Owner's Name_.__. ' -------------- Phong _tl . - Address.---------- Contractor sNama----- ......-••---------- -- -- ----• - -- - -=----- ---- -- -- -- jL_.------- Phone-/�`'dl---��i . 'Installation will serve: Residence par ent House ❑ Commercial ❑, Trailer Court E] Motel [I Other [:1 ' r Number of living units: /'___ Number of bedrooNumber of baths __ Lot size ---- -_ .___./_.. _____.- Water Supply: Public system ommunity system ❑ Private ❑ Depth To'Water Table &O'Oft. v` Character of soil to a depth of 3 feet: Sand-(:] Gravel ❑ Sandy Loam n' Clay Loam ❑ Clay ❑ dobe Hardpan [❑ Previous Application Made:,i (If yes,date-----------------_-) No E] 'New Construction: Yes ❑ No FHA/VA: Yes El No El TYPE F INSTALLATION AND SPECIFICATIONS: w (Nojc tank or cesspool permitted if public sewer is available within 200 feet.) pticbF; Distance from nearest well_________________Distance from foundation--------------------Material_-_____________________-_-------_--__-__________- _ No. of compartments-------�--------'Size---------------------------------Liquid depth--------------------------Capacity--------•-------------- s Distance .•�/ .p . from nee st well-�lE�1Distance from foundation___:__�__-____Distance to nearest lot line... ..... ..... Number"of line _ _____-_1____ _ _-_Length of each line3&. _ !!_-Width of trenchp,Z �(___ t Type ofl filter material ._. _ Depth of filter material____ _-. __ otal length---------------_____ �________ ag Distance to nearest we dE15( ____Distance rom foundation___-_' Ta e to nearest lot line____ Number of pits___�- ---------------Lining materiald-Ck- Size: Diameter�- �-----Depth-�--- -�----• --------- Q Cess ool: Distance from nearest-well---------------__Distance from foundation--------------------Lining material__-___________________________-______ p _________Liquid Capacity gals. ❑ Size: Diameter--------------------------------------De th---------------------------•- -- -- ---------•----••-- ...-.__.. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------._...-------______-___:_--_-_. i ❑ Distanc2 to nearest lot line _-_-. - ------------------- Remodeling and/or repairing describe --- -------------- ---- -------------------•-------- - ----------------- --------------•--•--•-------•-- ------ -. � - w •--•------------- --- -----------•-•--------•---• ----_---• ------------- ------ -----•-- � ------•--------------------------- I --------------------------I hereby certify that I have prepared this application and that the work will a done in accordance with San Joaquin County ordinances, St a laws, a dG les nd regulations of t San Joaquin Local HE District. C. ' (Signed]t_LSL-- -- -------- �`'� `�"� = I----------------------------- By: ----------•----------------[ r r Contractorl By:----------------- -___U__----------------------- ---- --------------------------- -- ---- Title--------------------------------------- ------- --. [Plot plan, showing size of lot, location of system in relation t ells, buildings, et , can pieced on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDi;_.BY- DATE-- --—-------------------------- REVIEWED ATE ----•------------------------ REVIEWEDBY------------------- --II------------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED11 •-••------------------------ -------------------------------------•-• DATE_-----------------------------------------------------••-- Alterations and/or recommenefations•------------------------------ -------•------------------------------ s 7 E' ------- ----------- --------------------------------------------------------- ------------------ --------- � zf -----�)-.----- -- - ----------------- ...__. /Y /J - --- - FINAL INSPECTION BY:" . r f �T- - ----------- � 7r----•-- ?--------------------------- ------------------- - Date--------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West Stir Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS