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FOR OFFICE USE: 1 ------- Permit No. _-1��-�� " APPLICATION FOR`SANITATION PERMIT ------------------------------ - (Complete in C7uplica#e) issued Date 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. t(p /4;o� ------ ---------•-- JOB_ADDRESS'AND'LOCATION--)5'1- -------- fQyr .. .lY� -�t ------- --- Phone. Owner's Name-- r-o+�-------- ----------- - ---- .. ------------------------------ Address------------- -- --•--------•-•--- f Phone.-----------•-------••----"---•---- ------ --------- ----------------------------------------•---------- Contractor's Name---- ---------•-----•------•-----"•----...------------ - Installation will serve: Residence 14 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other C1 -- Number of baths _X--- Lot size --- /� -------------------- i -"__ Number of bedrooms -"� --" - --""" ' Number of living units: _11" - Water Supply: Public system ❑ Commuriity system ❑ Private ® Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------- } No ❑ .New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: , Distance from nearest well-----------------Distance from foundation-------------------Material------------------------------------------------- No. of compartments-------- ------------- ----Size-------- -----------------------Liquid depth--------------------------Capacity------ Disposal Field: Distance from nearest well---------- ---Distance from foundation-----__------------- Distance to?nearest lot line Number of lines-----------------------------------Length of each line-------•----`-�-------- Width of trench----------------:-- ----------------- ❑ -------Total lin th-----------------=--------------- ------ Type of filter material_"---"__".-.-"-_--"----"De Depth of filter material g p y Distance to nearest lot line-If- � '� � Seepage Pit: Distance to nearest well-_ -"_"-----Distance from f undation._"-- ------------. bo Number of pits-----1----_--..------Lining material__ Size: Diameter" --- -----------Depth--- ' Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------------------------------------- 1 ❑ Size: Diameter-------------- --------- ---------.Depth ------------------------ ---------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------- ----------Distance from nearest building-__------------------------ ---------.-. ❑ Distance to nearest lot line--------- --------- ----- ------- ------------------ ------•------•------- ------------- ------------------------------ Remodeling and/or repairing (describe:__"_- - - ' ""'� -- r'2.1.�i ----- --------------------------- �'��` ------•----------------------------------------------------------------------------•--------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. mxx------ a4A( g _ .y-_. — " -----------------_----..--_(Owner and/or Contractor) Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ;?. -------------- DATE-I a---7 -6` -----------------•------------------- APPLICATION ACCEPTED BY__ e ------------------- REVIEWED BY--------------------------------------------- --------- - "------- --------------------------------- ------------------------------------------ D ATE------------•----------------------------------------------- BUILDING PERMIT ISSUED----------------------------- ------------------ ------ ----------- --------- DATE-- -- --------- "---"------------------------------------------------------------------•------------------------ -- Alterations and/or recommendations ------------------------ --------- ----------------------------•-----------•--- ---------------------------"----- ------------- ----------------------------- -----I �------ -- -------- ------------------------------ ------------------------------------- -----I-------------------------------------------------------------------------------_ FINAL ------------------------------- FINAL INSPECTION BY:A-- .. . - rt_ '�€ -------------------- Date/..Z �,r------------------------------- -------------------------- SAN ---------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REviSEO 13.59 3M 3•'63 F.P.C13.