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FOR OFFICE USE: <�/1-/ V--- ----- ----------/ e o APPLICATION FOR SANITATION PERMIT Permit No. .. �'. - - ------ - - ----------- - ld (Complete in Duplicate) __ ___.___._l/: 0_ This Permit Expires 1 Year From Dat_ Issued Date Issued .-- t � e 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 with County Ordinance No. 549. x � 6 -^t------------------------------------------•-----------•---•------------ JOB ADDRESS AND CAT10 - OwnersName-------- ---- ----------------------------------------------------------- ------------ r -------------------_-- Address-.--.-------- :Y ---------------------------------------------------------------•-•-----••--•--------------- Contractor's Name----- - -------- - -----•- ----------- Phone----------------------------------- Installation ----------------------- --- -- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a s Number of living units: _ ____ Number of bedroom____ Number of baths I----- Lot size -------------------------- Water Supply: Public system ommu,4 system ❑ Private ❑� Depth to Water Tableaiyft. Character of soil to a depth of 3 feet: Sand� Gravel Sandy ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ p ❑ ❑ Y Previous Application Made: (If yes,dote------;r.___.__..__.l NodewiConstruction: Yes ❑ FHA/VA: Yes ❑ No�- TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted,if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well- r-_. -_Distance froryl foundation__ 49--------Material_ ____________ ___________________ No. of compartments_____- e _ .___Liquid dep+h_��___..--_ Capacity_ � Siz -------- --- ------------ Nsposal Field: Distance from nearest well......=�ance from foundation___.__ ._ ' �0------Distance to nearest lot line_ __�____. E �r Number of lines_______? ----------- Length of each line---� __ Width of french.. of filter material-__-/A- Depth of filter material---&.{,1______-Total length_/Sa/___________________________ Seepa t: Distance +o nearest well__ i`sfanFce o " foundation__-v__r_ Distance to nearest lot line__47/___._ Number of Lining material__ ._.___..Size: Diame+er.32.-L_-_.__-Depth- _^!95e_1___ Jr Cesspool: Distance from nearest well-_----_--------__Distance from foundation-------------------Lining material-._.___-___-__-----_____.____--_-_.- ❑ Size: Diameter -` ,,.Depth._p - ----------------Liquid Capacity-- ------------------------gals. E7 Priv Distance from nearest well-______________ __ ____________________Distance from nearest building ________- Y= R 9 Distanceto nearest 10�.t'rTne-..---- ------------------- ----------------- - --------------------------------------------- ------------------------------------------------- Remodeling and/or repairing {describe}:_________________ __________- -------------------------------------------------------------------=---------------------------------------------------------------- I hereby certify that I have prepare ' -------------------------------------------------------------------------------------•------•---------------_---- -----------------------------------}--------------------------------------------------- d this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules and regulations of the San Joaquin Local Health District! (Signed)------------------- �_sysfe, ------- ------------- --------- --------- ----- ------(Owner and/or Contractor) By:------------------------ ------ .-- ----- ---------------------------------------------------(Title) ----- (Plot plan, showing size of location oflation to wells, buildings, etc., can be;placed on revers 'cle). G,, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B - -- ------ .X�- ------ ------ --------------------------------------.- DATE---jz.- ----------------- REVIEWEDBY--------------------------------------------- ---- ----------------__----- ------ ---------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-----------------------14:- --------------------- -------------------------- ------ -------- - ATE----- ---------------------- -------------------------------- Alterations and/or recommendations:.��-.—.-=--�- ---- � ----- :.r'Y--••------------------------------------•------------------------------- l r / r-- ------ 1 �� -------- ---- ( ��' _--. -- l.�rz f� -- -- - ----- ---------------- -------------------- ----- � = ~ -- y� - -- ---- -- -- - - - FINAL INSPECTION BY: r . ... Y - ------------ -------------------- Date--1� - -------------- - - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street >. 124 Sycamore Street, 205 West 9th street Stockton,California Lodi,California * �„ Manteca;'california'- Tracy,California F.P.C❑.