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FOR OFFICE USE: f yn ------ - - ---- -- ------ - .dam'`_-____-__ APPLICATION FOR SANITATION PERMIT Permit No. ---- -- ---------------------------------------- (Complete in Duplicate) ---------------------- This Permit Expires 1 Year From Date Issued Date Issued ..... ........ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance wit County Ordinance No. 549. zoo F— ��P�WAr �®.� - JOB ADDRESS AND LOCATION _e--- Owner's Name-----------j _ ----- --------- Phone. =` p . TM. ----------- Address----------- f]. f fes' •---------•---------------------------------------------------------------------•k- _-------•------------ a Contractor's Name------- ------------------ Phone '� - Installation will serve: Residence ❑ Apartment:House ❑ Commercial W Trailer Court ❑ Motel ❑ Other El r Number of living units: " _ Number of bedrooms _�+ '_ Number of baths _ __ Lot size Water Supply: Public system ❑ ,Community system ❑ Private Zr0TDepfh to Water Table 46. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2-09ardpan ❑ F Previous Application Made: '�(If yes,date------------------..-). No j2- -New Construction: Yes �o ❑ FHA/VA: Yes ❑ No i-^ TYPE OF INSTALLATION AND SPECIFICATIONS: r t (No septic tank or cesspool permitted if public sewer eis available within 200 feet.)/ Septic Tank: Distancelfrorn nearest well_/vP.__Distance j rom foundation_.240_________ _.__-___. ®� No. of compartments_.__A _ y ---- -- Size- - „cele---------Liquid depth-..J----�--------------Capacity_�. ��W- .-_-.-.- .._ __Disposal Field: Distance from nearest we .4AQ... Distance from foundat' . j ®� Number of lines______ae_.._._ __ -rr� Length of each line--- _e_.ff Width of #renchr_�:'__ '__.__________._ Type of filter material_ A_ {jsDepth of filter ma#eriaL__/' _.._Iry_____.Total length-._ ' s Seepage Pit: Distance to nearest well-._/ _ ___Distance fr m foundation--- Dist nce to nearest lot line-4- __.._ t ---Size: Diameter-_: __ _ ' -_---.Depth-.2•-- : I [� Number of pits-----srR.---_--------Lining material-- - - .. � ---- .a�J --------------------- ` Cesspool: Disfance'from nearest well-----------------Distance from foundation__________---------Lining material__._____-__.____.._._____________- - ❑ Size: Diameter--------------------------------------Depth_---------------------------------------------------Liquid Capacity----------------------------gals. i .Distance from nearest building Priv Distance from nearest well----------------_----------------Y' ❑ Distance,to nearest lot line-------------------------- ------ --------------------------------------------------------------- - t Remodeling and/or re aurin describe ---- �� ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------- ------------------------------------ -----------------------•------------•--------------------------------------------------------------------------------------------------------------------...---------------------------- 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, an rules and regulations of +he San Joaquin Local Health District. ` A � (Signed,------------ - - - - - ------ - '° -- - --- --------------- ----- /or Contractor) By: ---------------------- --------------- - -------------------- ------------------------ - - ------- - (Plot'plan, showing size of lot,'location of system in ation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY Q APPLICATION ACCEPTED BY DATE------- ----- --------------- REVIEWEDBY--------------------------------------- - - ----- -------------------------------------------------------------------------- DATE-------- -------------------------------------------------- BUILDING PERMIT ISSUED----------•--------------------------------------------------—-------------------------------------- DATE------------------------------------------------------------- ,�Alterations and,4o commendations: -----------------•------•-------------------------------------•---------------------------------------------- F,!�Q•7.w^'�- ------------------------------- ---------------------- ----- -- ---- --- --- -: ------- ----- ,�-.y-` !l„11-1------4_ L � - ; - ------------ FINAL INSPECTION BY:.--------41-=.-�'” R '- --"� `l�'` --- ------ - ---- -------------- -,- -- Uate-------- -- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1607 E.Naalten Ave, 300 West Oak Street 144 Sycamore Street 205 West 9th Street -' Stockton,California Lodi,California i Manteca,California Tracy,California F.P.CO. f