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FOR OFFICE.USE• � � A//01 0 / -- = a l y IN APPLICATION FOR SANITATION PERMIT Permit No. ....,_____ - --------- ------=------ 17 -------------------°��--- �M (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 incompliance with County Ordinance N . 549. t JOB ADDRESS AND!;;; �� ION----------_1---C --/ Z ---- -- Lit Owner's Name-----------'---_ •'`& •---- — Phone. t Address--•-------_-----------l� SII' IL ' L . Contractor's Name-- ( .`--- � "` Phone ` -••• filer Court Motel Other ❑ Installation will serve::Residence �rtment ouse ❑ Commercial ❑ Trailer ❑ ❑ _ r h '' � f -------------- �Number of living u its: __Number of bedrooms _�_ Number of baths ________,Lot size __/�i-- Water Supply: Publie�system �c mmunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to aiidepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cl;5_FHA/VA-..:Yes Adobe ardpan ❑ Previous Application Made: (If yes,date__-_- ,--__-.-1 No ❑ New Construction: Yes ❑ No ❑� No ❑ . ip it . . �.. TYPE OF INSTALLATION AND'SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is-available within 200 feet.), 3 T k Distance from nearest well______________�''Disfance .from foundation_ __._._________Material.__._________-__________.-__________ ___-_____- . No' of compartments---------------------- Size------------------ y Liquid depth------------------{o---capacity------------i--------� D• sal ie d: Distance-from nearest wellA4v_A,,, Distance from foundation'I_- -- -----.Distance est lot li�------ D* ____ ~ { a + Numb r.-of lines------- ----- --------- --- - --Length of each line'P-Q_ !---------------Width of french____- -----------'�. - ,��} Type �f:filter materia l-�-Depth of filter material----- q______---Total length---------------------- -Q ------ �I' I�t' �- See ge Pit: { Des#ante to nearest well--�-C'!___ -____Distance from foum.ndation_��_`_____.Distance to nearest lot line______ _______ 11 ff �� Num :0 ber of pits-----F_- Lining material_- v- -------Size: Diameter___,4_Z---- -----Depth----��p-5 .-_------------ -- J. Cesspool: Distance from nearest well_________________Distance from�ounclation---_--_-__--__----.Lining materia!__-_____--_-__--__--._____-______--_,,.� ❑ Size: E)iameter-------- ------------------- --------Depth----------------------------.-------------------- Liquid Capacity---------------------------gals, Privy: s Dista nice from nearest well-_-____---_______ ____________________-______-_Distance from nearest building_____---_-_______----_ ---____-_. ❑ Distance to nearest lot line----------------- --------------------------------------------- ------------ -----F --'----------------------------------------------- ---------- . Remodeling and/or repairing (describef------------------------ -1-------------------------------------------------- ` ---- ---- --- --------------- --- -- ----- N---- -------------------------------------------------- - 1--1I-4----'Ill:--------------- ------ ------------- - --- ------------------- ------ ----- -------------------------- -------- ------ I hereby cert ify��thaz have prepared this application and that the work will be done In accordance with San Joaquin County ordinances, St t law`s, an rules and regulations of the San`Joaquin Loca Health District. I Con+ract (Signed)------------------- By: -------- I` .�; ( �- � � .. By:-------•-•-----€l�------t----------------------------- ----------------- _ :- - (Title) ---------------------- ------- ------ ------ (Plot Ian, showing size of lot, location of system in rela}ion t wel[s,.buildings, a ., can be placed on reverse side). , P g s.il II! 41 FOR DEPARTMENT USE ONLY s�F ilk APPLICATIONACCEPTED BY--------------- ------- ------------------------------------------------ DATE-------- REVIEWED BY----------- --------- ---------------------------------------------- - BUILDINGPERMIT ISSUED------------------------------------------------------ ------------------------------------------- DATE_------------------------- ------------------------- --- Alterationsnd or,recom endattons---------------- ---------------------------------------------------------•--------•-----------•-•------------•----------------------------•------------_------ Il� . --------------------------------------------- ---------------- ----------------------------------------------------------- I� 1 '�!i - ---------- ---------------------------------------------------------------------------------------------------------------------------------- --------- ...... ----------.----------------------------------------------------- --------------------------------- I) !i FINAL INSPECTION BY:.-- �--- Ct-- Date Date P�` f. SAN JOAQUIN LOCAL HEALTH DISTRICT i1601 E.Nazton Avg. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californlia Lodi,California Manteca,California Tracy,California .II, 11' ES 9 REVISED 8-S9 3M 3-'6hh3 F.P.Cd.