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FOR OFFICE USE: a --- -- -------- - APPLICATION FOR SANITATION PERMIT Permit No. . {Complete in--Duplicate) ;2-3-9'` ---------- --------------- bate Issued -- ---- _--_ ` This Permit Expires 1 Year From Date Issued ^%° ��- _ S Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he described. n This application is made in compliance with County rdinance No. S49. ------------ ------- ---- -�-- t_ _ JOB ADDRESS AND C ON--- 9-A&S - --- -°----- -- ---- 1�M- -------_- ---------------- -------- ------------- Phon .- -&7P--- Owners Name- ---- ---•-- ------------ --- „s } Address--------------------—75 - -------------I----- r Contractor's Name-----------------•--------- ___ M I Other ❑ -- Phone _ Installation will serve: Residence Apartment House ❑ Commercial ❑ 'Trailer Court ❑ ote ❑ F -- Number of living units: _ _.-_ - Number of bedrooms __ .____ Number of baths � Lot size.__-Q----/K--,/-S- -•-r----=------------------ Water Supply: Public system ❑ Community system ❑ Private ❑ "'Depth tolWater Table --------- ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ' Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ I W FHA/VA: Yes E] NoX Previous Application Made: (If yes,date.__------_-------- ) No X New Construction: Yes ❑ No t � 1 TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic •tank or cesspool permit+ed if public sewer is available within 200 feet.) ` Se tic Tank: Distance fromr#earest well___________--.__Distance from foundation ______.________.Material________________________._--___________--------. P Liquid de th--Distance to nearest lot line___ - fll�Ca^ No. of compo meats--------------------------Slze---------•--------------------- q P. i I s--------- Disposal Field: Distance from r barest weiljVfll �_.Distance from foundation__, - .______. } !� Number of lines_. --- Length of-each line-----------------t--- Width,of trench.. __--------------_ r rr Type of filter material __ ... _Depth of filter material___I-9-------- i----Total length----,�a----------------•------------ --- ------ f `� Seepage Pit: Dis#ante to nearest welL.�L/ l `� -- Distance fro foundation___,3 _____ Distance to nearest lot line ___------------_ }�!r it 1 -��1-�_ Lining material_�L_.� Size: Diameter3,J--_ -,__,.Depth-- .� � - ---:3 I�umber of pits.. _ _. _ .. g 4 Cesspool: Distance from nearest well.-----------_----Distance from foundation ._ Linin material_ gal Size: Li uid Capacity 5 ❑ q p Y---------------- 5ize: Diameter---�------------------------------ --.Depth ---•------ ------- LL -__-Distance from nearest building__________________.___---___-___-_.__... Y Privy: Distance from nearest well--.______------------------------ --- ❑ ------------- Distance to nearest lot line=------------------------ ---- ----- ----- ------------ ------ O Remodeling and/or repairing describe):__ ,_.-_ - .-.--- -- -- --- ------------- -- -- l -------------- ---------------------------------------------------------------------- -- - - - - ------ t -- ---- -------------- ----------------- y L b----------- -- ---------------------------------- ---------- ------------------ i epared this application and that the work will be done in accordance with San Joaquin County I hereby certify that I have pr ordinances, State laws, and s grid regulation f the San Joaqui - ocal Health District, ----- (Signed) -- --- - r ---- ------- - (Owner and/or Contractor) i By:----------- `; . . . (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plat on reverse side). ! i FOR DEPARTMENT USE ONLY f° DATE - �� I. APPLICATION ACCEPTED BY-----_--- - - - ------- - --- ----------- ----------- - ------------ DATE-------- ----------•---------------------------------------- REVIEWEDBY------------------------------------------- ------ ------------------------------- ------------ DATE------------------ ------------------------- --------------- BUILDING PERMIT ISSUED----------- ------------------ - .-_ -_C �- Altera+ions and/or recommendations: ---�`-��------- --�-•-•-----�------•-----------------•-- --•-------------...------•--------- ------ --------- - --------------------------------------------------- ---- --------------------------------•----------.-- .I f. ----------_---------------------_ --------------------------------------------- FINAL INSPECTION BY:.____.---.�-- ------------------------- Date-- ------------�� ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E:Hoiefton Ave. 3o0 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California PLodi,California . Manteca,California Tracy,California C , F. .CC- i