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FOR OFFICE USE: - ----------------------- ...... --------------------------- --- ---------- APPLICATION FOR SANITATION PERMIT /Permit ------------ -- ----- --------------------------------- (Complete in Duplicate) -------------------------�__A-------------- ------------- This Permit Ex fres I Year From Date Issued "*Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install f Work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.,--- ;�' GWNED - 1 41ul ;--i ------0,Vx�_ ----------------------------------------------------------------------------------------I---------- I Owner's Name-------- X I&-- --------6 ----- ------------------------------------------- ------------------------------------------------------------- Phone--------------------_--_-------- Address------------C-26;-�_ _ .. I Contractor's Name-------y ----------S Y__� q --------------------------------I----------------------------------------------------------- --------------------.-, Phone----------------------------------- Installation will serve: Residence,�Xpa rtmenf House ❑ Commercial 0 Trailer Court [-] Motel ❑ Other ❑ Number of living units: _-1---- Number of bedroom's J---- Number of baths 2 Lot size ---15"49 1--_---- _---..-.-.._--------------------- Water 1-- ---- ------------------------------- Water Supply: Public system E] Community system E] Private F-i Depth to Wafer Table ff. • Character of soil to a depth of 3 feet: Sand Ej _] Grav'l F Gravel Sandy Loam E] Clay Loam [] Clay [] Adobe [�`Rardpan Ej Previous Application Made: (If yes,date--------------------) No New Construction: Yes ET4,'No Ej "FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cessp'001 permitted if.public se-wer is available within 200 feet.) Septn' Tank` — Distance from k nearest well-----------------Distance from foundation----.-._--------- Material------------------------------------------------- No. of compartments--------------------------Size I-----------------------------Liquid depjh---------------- ---------Capacity_-------------------- ji Dis Distance from nearest well-----------------Dista`nc(�`fro�h foundation------- --_-..Distance to nearest lot line---.---.-----.--- p6V4* Number of lines---------------- --------- -------Length of each line----------------------.------.Width of french------------------ --- ------------ Type of filler material--------------------_---Depth---Depth of filter material----------------------Total length----------------------------------------- Seepa Distance to nearest wel.1-—----------------Disfance from foundation--f-4...---........Distance to nearest lot line�r-_ Z tr ;--------------- El Number of pits---/-----------------Lining maferial_?0_CA------ Size: -7�------------------- Cesspool: Distance from nearest well-----------------Distance from founddfian--------------------Lining material------_-------.----.--___-----------. ----------------------- ----- Capacity-.--------------------------gals. ['w❑ Size: Diameter ;--------Depth------------------------------------------------------------ ---------------------Liquid Capacity-.--------------------------901%;. Privy: Distance from nearest well_...____ --------------------------------Distance from nearest building------------------------------------------ F1Distance to nearest lot line--------------- - -------- --------------------------------------------------------------------------------------------- - Remodeling and/or repairing ..... ......7 ----describe ------- -------z-•-_- -------- --------- ---------------i� ---- - ------ t-------------- ------------------------- -------------------- ----------------- - - --------- -1 - --------- ---- --- ---- --- ----- ------------------------------ ---------------------------------------------------------------------I-------------------------------------------------------------------------------------------------------- --- ----- 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, end rules 'reguations of the San Joaquin Local Health District. (Signed)----------- --------- ----------------- ------- ---- -- ------------------ -------------------:-------------------------------------------- .J-_(Owner and/or Contractor) ., i By:-----------------------------------------------------------------------I----------------I---------------------------------------------(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 APPLICATION ACCEPTED BY-.-.-------- ------ ------- ------------------------------------------------------------------- DATE... ----------------- REVIEWEDBY----------------------------------------- ------------------------------------------------------------------------------------ DATE--------- - ----------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------- ----------- ------.__ DATE------------------------------ Alteopfions an or recpmmenoaf ions:-------__------------------- ------------;-�-----------11-------------------------------------------------- ------------------------------------- ------------------------ - ------%-_er------------------------------------------------ -- ------------------------------------------------------ --- - ----- ------------------------------ ------------------------------------------------------------------------------------------------ Z, .-)--- --- --- -------- <9?------------------------------------------ ------------------------------- - ------------------- ------------------ - ---------- - ----------------------- --------- ---------------------------------_---I-------------------------------------- --------- --- ---------------------- ------------------------------------------------------------- FINAL INSPECTION, BY:---------- =---------- ----------------------------- Date....-.._?- a-? -�64 ------------------------ ---- -----_----------------------- ------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street, 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.i;C3.