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°� FOR OFFICE USE: � 3 ---------------- APPLICATION �. � Permit No. ._ ----jet--------- ` FOR SANITATION PERMIT ----- -`` {Complete in Duplicate), _ . /r7 ----- ----- ------- ------------- -------------- ----- -� - . Date Issued-.. ---- -------�---,�3 € This Permit Expires 1 Year From Date Issued 11 Application is hereby made to the Son 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. a ;� tr ��,��// JOB ADDRESS AND LOCATION...-_74:1___.8---p �T_ T = ' ' - Owner's Name_____/)_ -__ Phone-----: ----••-----•-----------•- ��+" ---------------••--------------------•-•--------- Address --- - _ ---- Contractor's Name------ - Phone.. Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --------- Number of bedrooms -------- Number of baths ___t___ Lot size ------- -----•--------------------------- 4 Water Supply: Public system El C8 system El Private �epth to Water Table "-:Oft. � t t Character of soil to a depth iof;3 feet: Sand C] Gravel El Sandy Loam.E3 Clay Loam ❑ Clay E] Adobe Eardpan ❑ Previous Application Made: (If,yes,date___ _______________) No :[�New Construction: Yes E] No L�'FHA/VA: Yes ❑ No [�}� TYPE OF INSTALLATION AND ,SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r a .r ... Septic stance from nearest well__ ------,Distance from foundation__________________Material- _______'------------------------------- septic ________:_____..-- __-__._. ❑ o!-of compartments..___'w_::............ Size-'� Liquid depth--- = =Capacity...---------•---------- Disposal Feld: ante from nearest well-----_------------Distance from foundation_-_____+,_________:Distance to nearest lot line-____-_____.____. EE] mber_of lines---=-------------------------------Length of each line--- -----`------------------..Width of trench r ype offilter material---- `---------------Depth of filter material--_---:=---------------Total length--;.------'-----_-----------y ----- t t r s I 00 Seepage Distance to riearest well_/&_a_____I'------- from foundation---Jp----------.Dista Distance to nearest lot line .r`.�_-___,___-_. D Size: Diameter____ Linin material__?:��-- 0� .---------Dept h- --------------- Nu3mber of pits-_�_____.-- -- g 1/� I t i 1 Cesspool: Distance from nearest well----------------'Distance from foundation..--___.-_______--.Lining mat erial__._____.._.______--______..________ El Size: Diamefer.--- ----- ----------- ------Depth-----------------------------------------------------Liquid Capacity- --------------------------gals. Y ! 1e f ; l I Distance_from nearest building -------_----------- -- Privy: Distance from nearest well-------------------------------------------------- ---•---------------------- ------- ----� ❑ Distance,to nearest lot line____________________--------------------------------------------------- -------------------•-------------------------------- ' Remodeling and/or repairing (describe):------------- ------------- ---------------------- ------------- �] . t i""'j --------------------------- --------------------------l ' i ------------ -------------- ---------------------------------------------•- -- --------------------------------------------------------------------------------------------------------------------.. . ------------ --------------------------------------------------------------------------------------------------------------------------------------------------- ----- --- ------ --- - q Y I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules l=and regulations of the San Joaquin Local Health District. (Signed)-------------------------------------------------------------- - ------ ----------- -----------IOwner and /or Contractor) BY:----------------------`------------------ - ----- I---- - ---- - - -- ------------------------------------------------(Title)-------------------------- ----- ..--- (Plot plan, showing size of lot,.locat tem in relat' n to wells, buildings, etc., can be placed on reverse side). r FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -V ^--- -- ----------------------------------- •----------------------- DATE----I-C?--- �-�----------=---------- REVIEWEDBY--------------------------------------------- ---------- ------- ---------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------:----------------I------------------------- --------------------------------------- DATE------ -------------------- -- ----------------- ---- Alterations and/or recommendations:___I O'- _ --�------- ---1--- �-�- � ` - ------ i v . � FINAL INSPECTION BY:---fk,--- ----- 4 �5------------------------ ISAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r CS 51 REVISFO B-59 3M 3-'63 F.P.CC.