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FOR OFFICE USE: -------------------- ---fin ' c __.__.._.___r---------------- ------ - ----------------- APPLICATION FOR SANITATION PERMIT Permit No. .-- /_- ----------- ---------------- -- ----------------------- (Complete in Duplicate) --- -------------- This Permit 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 com fiance with County Ordinanc No, 49. JOS ADDRESS AND LOC Tl Q_� L -- - --- ---- -- --- --- Owner's Name- ---- -- ------ ----- -- -- ---- 11----------------- ---------------------------- ------ Phone------------------------------------ Address---------------------- ---•--------.------•-•-•--•-------- Address---------------------- + 4 Contractor's Nam -- ------ Phone_ .� s .1 e-_ - Installation will serve: Residence Apartmen House ❑ C�ommeerrRciial Trailer Court Motel Other Number of living units: _------- mber of bedrooms -------- Number of baths -------- Lot size ____-.._____ -__-__.-._..-_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay dobe �rdpan 11Previous Application Made: (If yes,date--------------------) No El New Construction: Yes El No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 S tic. Distance from nearest well-----------------Distance from foundation------------------- Material-------------------------__-----_-_-....______-. No. of compartments---- - -- ----------Size-------------------------------.Liquid depth--------------- ----------Capacity-----------------------� P Distance from nearest well_ Distance from found#f- n,____ ______.Distance to neares of ma___-- (�- Number of lines___._____ ____ __ Length of each line_ fWidth of trench-Type of filter materia Depth of filter m eg ---------------------- X _- - - - -------.Total length -- ------- epa e Distance to nearest well_. _ Distance fro foundation__/_ __._____.Distance to nearest lot�liYle� ;Q__ Number of pits ----------------- material_ D Size: Diameter-___. f�___.Depthf_�) �.�. ____._ ' Cesspool: `: Distance from nearest well-----------------Distance fro foundation--------------------Lining material-----------------.._.__-_--------.-. ❑ Size:.Diameter--------------------------------------Depth------------- -------------------------------------Liquid Capacity----------------------------gals. 0 Privy: Disfance,from nearest well-------------------------------------------------Distance from nearest building---------.-------------------------------- ❑ Distance to nearest lot line----------------------------- --- -- ----------- Remodeling and/or repairing (describe)---------------------------------- ------ - ---- -- ----------- - t ---------------- 1 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the w rk will be done in accordance with San Joaquin County ordinWejaws, and ules and regulations of the San Joaquin al Health District. (SignI� &1------ ^------------- --------------- ntractor) P B Title - r (Plot plan, showing size of lot, location of system in rel t n to wells, buildi gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - ----------------------------- ------------------------------------------- DATE------Z?'_:7Z`4_'(�-�_-------------------------- REVIEWEDBY-------------------------------- - ------------------------------------------------------------------------ DATE-------------------- BUILDINGPERMIT ISSUED---------------- -----------------------------------�---/------- -------------------- --- DATE------ --------------- --- I+erafions and�r.recommendations:_-- r,.r..__`tG' _ ---�__ � " '_------ r�r-----.. -.-- ----------- ---` -- ----- _ _ .¢E �---- 4 ----------------------------------------------- -/ ---------------------------------------------------------- --- --- - -- ------------------------- ----------------- -----------•-------- ---------------------•------------------ ----•-------------------------------------- -------- -----•--- ------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- - -----------_-------------------- l - -------------------------------------------------- I-------------- --------- -------------------- -------•------------------ ------------------------------- ------------ --------------------------------------- FINAL INSPECTION BY:.G?�."__...: �� < - �r� ----------------- Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California r.R.CO.