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I F R OFFICE USE (�� Permit No. -/ �°'u -------"------ - APPLICATION FOR SANITATION PERMIT u�G- -------------- [Complete in Duplicate) Data issued __.. A �t -- - ?This Permit Expires 1 Year From Date Issued nd install the work herein described. _ Application is hereby made to the San(Joaquin Local Health District for a permit to construct a This application is made in compliance with County Ordinance No. 549. --------------- JOB ADDRESS AND LOCATION _..------ - i-- - •-------�'�- ------=--- -"-- =•--- ---- -- . -------- Owner's Name_____ _ _--.- =- fi Address--- -----•-• --- --- one •-•----•------•---•---------- Contractor s Name------.�`_��- --- -- ------ ---------------�----- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _--(_-_- Number of bedrooms ___ - Number of baths2-z-Lot size _ ___ Water Supply: Public system El [ICommunity system Private Depth to Water Table IP ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam ❑ Clay Loam [I Clay E] Adobe Hardpan ❑ New Construction: Yes No� FHA/VA:Yes ❑ No Previous Application Mader (If yes,date_----------,_._ ---) No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) s Septic Tank- Distance from nearest well_-z_-__.__.--_--_Distance from foundation------------------ No. de th__Materlai_--- -=Capacity..____________________ �' No. of compartments. Size q p. Disposal Field: Distance from nearest well --------------DLength ofreach line foundation.:-------:-------W d6-oftfren'cne h est lot line-_---_----_------ ❑ ��,,: Number of lines-__________ Type-of filter material-------------------------Depth of filter material-------- Totals length___.____-----•---=---- t See age Pit Distance to nearest well_-f-00____-------Distance from foundation_-__�_�_.--•-- istance�rfoDep+�s# lot line--.,3_----- �J Linin mater�aL_ -- Size: Diameter--______ ___ _ !' e Number of its_...._ g p- CLs Cesspool: Distance from nearest wei!-----------------Distance from foundation------------------.. ininq material__..___________---------"--"--.als. C ❑ Size: Diameter------- ------------ '-----' ------Depth_ ----'--- ---------- ------- ---- ------- - -----Liquid Capacity----------------- ---------- [. Distance.from nearest building----------------------------------------- n Privy: Distance from nearest,well---------------------------- ------- ---- Privy . i ❑ Distance to nearest lot line---------------------------------------- - A / - 5_./�Y('--------- S — -----`---------------------------- .,, Remodeling and/or repairing (describe):__.___ alF ------------------------------------------ ----------------------" ---•---------------------------------------- --•-----------------•---••----•-------•---------------------- --------•------------------------------ - -------------- ---------------------------------'--------------•-----------•--------I------- ------- ---------------------------- --------------- - rk l I hereby certify that I have pre dis application the San Joaquin i h wo Health eDi District. ordinances, accordance with San Joaquin County � ordinances, State laws, and esregulations --' ----- - caner and/or Contractors (Signed _ -----� -��'= -- ----------�--------- ----- ------ ----------------------------------------------------- - -t---' -------- - -- -'- ------' ------ l� ----------------------------------------(Title---=----- -- - Pn By:--•--------•-- (Plot plan, showing size.of lot, location of,syste in relation to wells, buildings, etc..-.can be placed on reverse side). p. FOR DEPARTMENT USE ONLY ` DATE-------- "'r - /-�---------------- APPLICATION ACCEPTED BY _; DATE-_ /----------�------------------------- REVIEWED BY------'------------------------------ ------- ---- ----- ------------------------------------ -- DATE ------- .----`------------------------ BUILDING PERMIT ISSUED---•--------- ----------------------- ------------------------'----�------------- ---------�� --�� -.� '`---- Alterations and/or recommendations_______________ -------- �`' �"` _-----------.--- __.-____ 4'`-�_-1 --------------------------------------------- --------------- - �-- -� ------------------------------------------------ ---- --- . — - ..� -Date------... -- - —----- -------------- --------'- FINAL INSPECTION BY:-------- ----"!--_ 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 FS 4 REVISED 5-59 3M 3-'63 F-F-ca.