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=,FOR OFFICE USE: ; - --------------------------------- ----------- ---------- -------------------- -----._.._._.____.__.____ _ APPLICATION FOR SANITATION PERMIT Permit No. .rz�fl. .__ '" - - - --------------- (Complete in Duplicate) ---- This Permit Expires 1 Year From Date Issued Date issued 1lJ__/ _7 Application is hereby made to the San Joaquin Local Health District for a permit to construct nqt in all the work herein described. ; This application is made in compliance with County Ordinance No. 549. 2 !3_ !70 33 a JOB ADDRESS AND LO ATIO:'~% - :.. ----` - ------'/ -'=---- Y�L r--------- - Owner's Name - ,� Phone Address ----------?�--- -- --�- ---- '-- Contractor's Name-------------- .__p - ----- - --------------- -------- ----------------- -------------------•--------------------------•-------- Phone....------------------------------ Installation will serve: Residence A rtment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1..... Number of bedrooms _0- Number of baths Lot size __-.._ pp ----------- ---•- -------••-------------- Water Supply: Public,:system ❑ Community system ❑ Private Depth to Water Table I].____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay J4 Adobe ❑ Hardpan ",0 Previous Application Made: (If yes,dote._:.______.;__".---J No`,.,�' New Construction: Y No �J �❑ ❑ FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicise r is available within 200 feet.) ' Se f Tank: Distance from nearest well__ . _Dista fr nn n t�on__�_�______"__.1� eriaf__ _-- . ------ No. of compartments- Size ((oo i_Liquid depth_.___ J� p ,� _ �r� IPS CaPacityjti: Dis o ai Field: Distance from nearest well._:,] __ .._Distance from founclo,tio .-._r <_ __.__ istaq o nearest lot line_'.____.:_____. Number of lines______________ Len th of each lin `_ _ _ ___ � i th o trench.___ _-_ �-� ---------- Type of filter material 7_(__-� - ---Depth of filter material_____ --- Total length___,___-- 7__________-_______ Seepage Pit: Distance to nearest well...__--___--_______...Distance from foundation___________-_-___.Distance to nearest lot line_____________ __ ❑ lumber of pits----------------------Lining material--------------_---------Size: Diameter------------.----------Depth------.-------------------------- Cesspool: Distance from nearest well-----_ `-------Distance from foundation--------------------Lining material-----------------_--__.___________- ❑ Size: Diameter---.------------------ Depth - - ----.- ---- -------Liquid Capacity ----- -- - ------ --�-- --------------------------gals. Privy: Distance from nearest well___.__°------ ______________________.______..__-Distance from nearest building----------------------__- ❑ f Distance to nearest lot line__.____----_-_. Remodeiing and/or repairing (describe :-------- ----- - `-- ------------ -------------------------------------------- ------ --- ----------------------•--------------------------------------------••--------•------------------- ------------------------------------------------ ------------------- ---------------------------------------------------- ---------------------------- --------------------------------------------- -------------------------------------=---------------------------------------------------------•-------------------------- -- ---------_ x I hereby certify t 1 hav pr pared thisplication and that the work will'6e done in accordance with San Joaquin Coun� rdinances, State I and ru nd regulati of the San Joaquin Local Health District. S } (Signed)_-._:_-- _ " -- -1 _:•----- - -- - ►_ [Owner and/or Contractor) ----------=--------------- --------------------------- -•- - BY --------------- -- = {Title) ------ --� (Plot plan, showing size of lot, location of system in relafit an to ,wellsbuildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED BY--------- - --- ----- ----------------------------------------------- DATE----------- REVIEWED BY DATE_// r �f BUILDING PERMIT ISSUED._____---___..___""-- - J� �fi - 1 ------------------ ---- DATE. -------------------- ---------------------- -- Alterations and/or recommendations:---------- ----- - ------------------- ". 1 F --------------------------------------------_------------------------------------------------------.__-------.-----------------------v --------------------------------.-------------------.---------------._.____.___.____- f ---------------------------------------------- ------------------____-------------- ---------------------------------------------------------------_---_---------------_---------- .-' -----------__----------------------_---____ F _______________________________________ .w FINAL INSPECTION BY---------------------- ---- ------- ------------"�---- ------- Date-- ---- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1401 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street J Stockton,California Lodi,California Manteca,California Tracy,California