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FOR OFFICE USE: .__. _11__11 ��f -9. �--_-__._ APPLICATION FOR SANITATION PERMIT Permit No. ___... ............... `". G-• �-- .41: ��.� 1111. m _... .�, ----------------- l3� 9� 7 (Complete in Duplicate). ».� Date Issued �--- This Permit Expires I Year From Date Issued Application is hereby made to the San'Joaquin Local Health Dis'fict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc Ngo. 549. I r JOB ADDRESS A LOC ION �d "4J= €h Owner's Name-- f--------• •-- ry--- ----•- ------------------------ -------------------------------------- Phone-•---•-----------•-•------•-- .. !li , Address ------------ i . Contractor's Name---------------------------- � --•- --•-•-•-------...-•-- -----•- - ----•---- � .---•-- Phone e =_B.- . Installation will serve: Residence Apartment House ❑ C mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ hh Z . ` Number of living units: __f__ N ber of bedrooms _d___ Number of baths __t1ot.size 1111__ _... .................... Water Supply: Public system f Community system El 'Priv ate [ '' Depth to Water Table ft. r ., . , Character of soil to a depth of 3 feet:f Sand ❑ Gravel ❑ Sa idy Loam ❑ Clay Loam ❑ °Clay ❑ Adobe�ardpan{❑ Previous Application Made: (If yes,date _fl!,,TT _) No E] New Construction: Yes ❑ NoFMA/VA: Yes ❑ No ❑. TYPE OF INSTALLATiOWAND SPECIF A ON No septic tank or cesspool permitted if public'sewer is available within 200 feet.) 3 r i is ank: ? Distance from nearest well-__-_---:'._..Distant from foundation------------------- _.-.._.._________._______•---_------.---------. No. of compartments------------------•-__.--Size_...�'..-...-------------------Liquid depth_---------------- -------Capacity s Fit Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. Number of lines------------•----------------------Length "of each line?----------------------------Width of trench........................ of filter material---- ----- ---------'bipth ofy filter material-----------------------Total length.........-----------.------_--._.--.:-----47 � y y i Distance.=to nearest ell Distance fo dation...2.-5_.__.Distanco to nearest lot s [ � Number of pits____. .__..._____Lining material..! ...Size: Diameter... ____...___.Depth___.a.s................. Cesspool: Distance from nearest well______________ -Distancel�from foundation____.._-___.....__Lining material----------------__.--__-________._-_ Size: Diameter.......' De th �4 i ❑ P ----.-----Liquid Capacity-- .....-----------•-•-gals. € __._Distance from nearest building Privy: � Distance from nearest well- --------------------------=-`----------- 9---......-----------•--------------------- ❑ Distance to nearest loft line__.-- 1111-----------------h--------._ ._ - ------------------------- t � Remodeling and/or repairing (describe):----------------------------------------- I-•--•-•--------------------------------------------------------------...--•----•---------•------------------ --------------- '------....------------- ------------------------------------------------------------ iI-----•--...-----------------------------------------------------------------------------------•--••------•----- F ------------------------------• -•------------=----••-------••-•---------- ------ -------------- ----------------------------------------_-......----------------------------------- hereb c ify that I have prepared this application and��tl�at the work will-be done in-accordance with San Joaquin County ordinances, at laws4 an rules an regulations of the San Joalquin Local Health District. { a I (Signed}.. . ................. !. ... ..----••-------- ! .. --------- -- --- -- -- wrier and/or Contractor) By- {T'itle)--- ------------- ---- (Plot plan, showing size of lot, location of system in relation to wells uildings, etc., can be placed on reverse side). I '�. FOR DEPART' IENT.USE ONLY APPLICATION ACCEPTED BY--- - ------------------------------------ DATE- REVIEWED ATE REVIEWED BY k - � •-------------••------------------ DATE----------- PERMIT ISSUED-=----- ----•-°'- ,� ; -- r -------------- ---------- DATE- - -_-A4erafons and/or recommendatons------ - .. -------- n •- ----------------------------------------------------... -------------- -----------------------------------------------------------------------I--------------.......-•--.••-- I ---------------------- ------------------------------------------------------ -----------------------------------------------------------1 ......--•--•--... ------------------------------------------------------ ------1---111---------° , ---------- ---=•'----------------•-- ----------•-•--- -- -------------------------------- ----------------- ---------------- -------- --------- - 1111 .. .. . �' ---------------------------- ��jj J FINAL INSPTION BY .---_---- ---- ECDate----- �._ ._. ------- x/ -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street---.— 300 West Oak Srreet— w 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Cailfornla ... 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