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FOR OFFICE USE: ------------------- ----------------------------------- _ r� ------------=----------------------------- -----. APPLICATION FOR SANITATION PERMIT Permit No. _...Z. -5.... _! --------------------------------------------------------- (Complete in Duplicate) ` --" Date issued,..- :This'Permit Expires 1 Year From 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. JOB ADDRESS LOCATION- Uir ............. - AN LOC ----------------------------------- Owner's Name......... •---•---------� --- --------- -----------• ----------------Phone------------------- Address----------------•-•• --------- ----•- ` ------•-•-------------------••-•----------------------•---------------- ---------------------- ------------------------------------ Contractor's ------•----- -------•-- --•--- Contractor's Name ----------- ----•------ `'- ------------------------------------ Phone................................... '� ,Installation will serve: Residence [Er Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:______ Number of bedrooms '___ Number of baths _1_____ Lot size = Q�Z4S`V__.___.__._. _ ---------•-•-----•- Water Supply: Public system ®`Community system [-IPrivate ❑ Depth to Water Table eft. Character of soil to a depth of 3 feet: •.'Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobefT--Hardpon ❑ Previous Application Made: (If,yes,date_____.__._,_...__-) No W New Construction: Yes Er"'No [] FHA/VA: Yes ❑ No ❑� TYPE OF INSTALLATION AND.SPECIFICATIONS: `(No septic tank or-cesspool permitted.if public sewer is available within 200 feet.) f Septic ark: Distance from nearest we'll------------------Distance from foundation--------------------Material_.___________________.._ ____--___.__.__.______-. No. of compartm'nrs--------------------- Size-------------------------------- depth-------- Capacity----- ----------------- . r Disposal Field: Distance from nearest well__ ------._Distance from foundation-_,3P-e___._.._.Distance to nearest lot line-.� 1______ [gam Number of lines___ Length of each line______.._ "p g Width of trench---------;,'- --------------------- ma y --- Type•of filter material_.__./ Depth of filter terial-----/& ---- -----Total length--------3v%----------------- �I Seepage Pit: Distance to nearest well______________--------Distance from foundation--- -�_..------Distance to nearest lot line__`5___."""_"-"_ Number of,pits___ _: r _Lining mate Size:-__-"Size: Diameter______:3j`"-_ -.Depth------- - .n ,� r Cesspool: Distance from nearest well----------------_Distance from foundation-__________________lining material-___.____________"-__________.____ o6 I ❑ Size: Diameter. Depth -------------------Liquid Capacity------••---------•------- gals. I -� Privy: Distance from nearest well________________________ __---_Distance from nearest building Distance to nearest"lot line__,"__________________'�_.-. -------------------•-•---------------------•-•--------------------------•----------•--------•-------- .. A Remodeling and/or repairing (describe)----- ----------------------- ------------- •------------ -----•------ ---------------- ----------''-----=--------------------- ------ ordinances, $tate laws,, and rules and regulations li atifheon an Joaquin..Loc • •^ •• • - - n -- I�hereb certify that l have prepared this application and that the work will be done in.accordance with San Joaquin County Local Health District. (Signed)-------------------------- ----- ----- --------------------------------------------------•-------------------(Owner and/or Contractor) k"By:----------------_--------- --------•------- ----- -- = {rile ------------------------ -- ------ (Plot plan, showing size of lot, to system i, relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPT ED DATE 1 �`-------------------------------------------- REVIEWEDBY-------------'------------------ ------`-`-- - --------------------------------------• --".. DATE BUILDING PERMIT ISSUED_____________________----------------------------- .. Alterations and/or recommendations:____:._______:.________ _ -------------------- ------"--------------... -----------------•----------------- 4 1 ------ �= ••---- - - --lea = _ _.. -------------- ------------------------------------------ -------------------------------------- ----------------- -------- 3 -- / I FINAL INSPECTION BY: ;_i�.'. 7�i1-- _ - t Date -----102....4 v SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street '300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California E9-9{IEVISEo e•69 F.P.CO.7M s.da