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FOR OFFICE USE: __-__.-- APPLICATION FOR SANITATION PERMIT Permit No. ._ C;?.ti --------------------------------------------------------- (Complete in Duplicate) . --"" This Permit Ex ires I°Year Fjom Date issued - Date issued �� Application is hereby made to the San Joaquin Local Health District for a permit to construct andI .h This application; is made in compliance with County Ordinance No. 549. described.: JOB ADDRESS AND LOCATION_.__ �S- -------------------------I�, . ,(D Owner's Name- - -'�-•:- �_ ----------•--------------- ---- ----- ------------ Phone------------------------------------- Contractor's ' ---------------- Address----------- ------ . ----••------------"-------------------"---------------------------------------------------------------------- ----------•------------•- Contractor's Nama_____ /� - 1 ----- -----------•--------------- -------------------------------------------------- Phone.-----�.._.---------•------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _ Number of living units: ----V Number of bedrooms __Z Number of baths _-_ ____ Lot size _��_X" - Water Supply: Public system I -""-------------------------- PPy: r y ❑ Community system Private ❑ Depth to Water Table __.____ ft. Character of soil fo a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe pan 0 r Previous Application Made: (!f yes,date._--------- -----) No ❑ New Construction: Yes ❑ No ElFHA%A 0 s rd No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Sep is Tan`l;' Distance from nearest weft__----_--"__---__Distance from foundation_.___________°__--,Material--------------------- - No. of compartments---------------- ---------Siwe c - ------- ----------". ---Liquid depth-------------------------Capacity---------------------------- Number ---- - ------ - Disposal Field: Distance from nearest well'- ---Distance from foundation/o..------------Distance'to nearest lot line__ .--- �� Number of lines_______�------------------__ -Length of each line-___ g -3-'-- .Width of trench 9r N Type of filter material-' -o of filter material-__/ y - UI Seepage Pit: Distance to nearest well------------ -------------------Distance from foundation- / Total length___.._„ -------------------- �¢ -_ _.Distance to nearest lot line %.5- -- � Number of pits-----:I --_ --- -- Lining materia�O.G-- -----Size: Diameter-_ ,� ( ' Depth ...a0~---------------- <F Cesspool: Distance from nearest well-----------------D,istance 'rom foundation_-----------.-------Lining material_----------------------------- Privy: ------- ❑ Size: Diameter------------------ -- - -- ------- Depth_.__. � ..,:: - - - - ---- ------- ---------- - - -Liquid Ca aut gals Privy: Distance from nearest well------ _ ---------------- --- -----Distance from nearest building ❑ Distance to nearest lot line------------ ---- - g - ----------------- t ._ ---------- Remodeling and/or repairing (describe)____________________ I •- ------------------------------------------------------------------- --------------------- --------------------------------------------------------------------------------------------------------- --------------------------------------------- --------------------'----- --- --- ----- ---------- ----------- -------------------- = ----------_.-------------------------- I ------------------------ -- - ` I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy ordinances, Stater laws, and rules and regulations of the San Joaquin Local Health District. i (Signed)------ �. ----------------------------------- ------------------------Owner and/or Contractor By:-------------------------•----------•- •---------- - - Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY-----L__e_-_ = REVIEWED BY------------------------------------ DATE ------------- BUILDING -- -- ------------------ DATE- ---------- -------------- - PERMIT ISSUED-------------------------------------------------------------------------------------- ---------------------------- Alterations and/or recommendations-_=5 += ►�� �E i ----------- ------------------------------ --------------------- FINAL INSPECTION BY---- --------- �V ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT is 7607 E.Hazelton Ave. 300 West oak Street 724 Sycamore Street 205 West 9th Street Stockton,California lode,California j Manteca,California Tracy,California F.P.0 O. k