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FOR OFFICE USE: ------------- --- ----------- ---- APPLICATION FOR SANITATION PERMIT Permit No. ...ri� .1 ---- ------ ---- (Complete in Duplicate) ----------------- This Permit Expires 1 Year From Date Issued Date Issued Application is h'ereb'y made to the San Joaquin Local Health District for a permit to construct and install the rk herein described. This application is made in compliance with County Ordinance No. 549. ,..�-..T .2`7 `� �- mit•�e91 �• X � JOB ADDRESS AND L CATION. Owner's Name__- - Phone 4 ---- -----•---- - ------------- Address f .f, ------ •------ - r Contractors Name .` .... -t ---- ------... ----------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...... Number,of bedrooms - ... Number o baths rY Lot size --------------- --------...--------------------------_---.- Water Supply: Public system ❑ Community system El Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date----- ----- .....-) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ IN ❑ TYPE OF INSTALLATION.AND_SPECIFICATIONS: �,. _ -,� �-r-. - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------------=Y--Distance from foundation--------------------Material-------------------------------------------------- ❑ No. of compartments---- t---------- - ---Size-----•---- ---------------------Liquid depth_-- -----*:-----Capacity----------------------- Disposa field: Distance from nearest wei.-5-or- --.Distance from foundation...-- __----Distance to nearest lot line.X-------. X Number of lines------'../---------------------Length of each line...../-0.0-- -----------Width of trench....-------------- -------- Type of filter material_.- -S& -----Depth of filter material. ;-`—=_ --Total length.---/Z7`Q,--....------__..._.- Seepa it: Distance to nearest well....JO__Q_:_-.:.Distance from foundation__.. ....:...Distance to nearest lot line----------------- - 3 -----Depth_..-" s Numi�er of pits---------/--- Lining material--------'- '-----Size: Diameter-___.s '--------------- CesspooL• Distance from nearest well-----------------Distance from foundation..::.--:- '_ -.--.Lining material------------------------------------- ('-*1 ❑ Size: Diameter--------------------- - ---- - ---'..Depth-------- ----------------------------- --------'..Liquid Capacity--- ------------------------gals. Privy: Distance from nearest well-------- --------------------------------------Distancefrom nearest building....__-____..........._._-.___-.__._-... ❑ Distance to nearest lot line Pt ----------------------- -------------------------------------------- A ----------- ---- --- ----------------- Remod�Ilig and/or repairing escribe :-- -----.. ----- .f----=------------------------••----------------- r ---------------- , f ---------------------------------------------- ------------ ---------•------ -------------------- ------------------------------------------- ------------------------------- --------------------------------------------------------• -------- ----------------------------------------------------------------------=------------------------------------------- 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 Districts-- , (Signed) ------ _ esbildings, ---- -------------- nd/or Contractor) BY•------ -•---------- -- ---- ITltle}(Plot plan, showing size of lot, location of system in relation tow etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTEDBY ---------------------------------------- DATE.-- _ � r� + REVIEWED BY------------------------------------- - -------------------------------------- ------ ------ DATE------ - ----------- t BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------ --- Alterations and/or recommendations:--- --- -------------------- ------------------------------------------ - ! ------------------ -------------------------- -- ---- -- --- --------------------------------•---------------------- ------ ------------------------------------------- ----------------------------- -----------------------------------------------------------• ----------------------------------- -----------------------••---------------------------------- ---------.---------------------------- ----------------- ---------------------------- ---------------------: ---------------- ------------ --------- -------------- ------------- - -•---------------------------------------- ----- --------------—--------- FINAL INSPECTION BY C------ ------------ Date..6s.. •rC? t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street y Stockton,California Lodi,California Manteca,California Tracy,California I F.P.C C.