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FOR OFFICE USE: 0 I! -------------- ------------------------- -- ------- - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _s��_._f-�--- ---------- ---- ----------------------------------- ! (Complete in Duplicate) Date Issued _--------------------------------------------------- --- This Permit Expires 1 Year From 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 compliahce.with County Ordinance No. 549. �}t�•o� �a5 2OQ—i'2 JOB ADDRESS AND OCATIOW_ fir? - C---- ---- --- -- -- vi. __ ------- --- 4 --- �+ Owner's Name----- y Phone------------------------------•----- -- ---- ---- - - Address ------- - ----- = a - ------- - ------------------------------ ---------------------------------------------- L Contractor's Name--- t._...: -- ---------------•----- Phone------------------ ...-------� Installation will serve: Residence I] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ OtherLj/,l Number of living units: `__1_.= Number of bedrooms _Number f baths __ _ /___ Lot size ___________________ __ --------------------- ------ Water Supply: Public system ❑-. Community system El Private [Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay L'] Adobe ❑ Hardpan Previous Application Made: (If ye ,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ sh TYPE OF INSTALLATION.AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l J Sep�lc/ank: Distance from l�nea`rest well----- a.------ Distance from foundation_�_A__________.Material____._ __ _______.____________.__________. No. of compa'tments_-_______.____ � _ j �� Size` Liquid depth-------------------- Capacity--�� d Dispo Field: Distance from�pearest well __4d_/....Distance from foundation.___©/-------Distance to nearest lot line_✓r---.__-_._____ Number of,line: W _______.___.._____.._ __�_________________________Type of filtermaterial----S__R_________-__Depth of filter material_____ Total length__ See pae Pit: lmr �e5� I ..___._Disteince fomfoundation -- e -Distance to arestltlinS - Nubeof prts. _ YLining material_-___ _ zDiameter Dep ------------------ 'f . _ -�____- j' Cesspool: Distance from nearest well----------------- from foundation-------------------- material__.__.___________-__._____.____.._. ❑ Size: Diameter ------------------ m - De h- t -- -------------------- Liquid Capacity els. � p__.- - --_._ �-�-.- -----------------g , Privy: Distance frojnearest well________________________ -___. -__--.._Distance from nearest building I ❑ Distance to nearest lot line----- --------------------------------------------------------------------------- ------------------------------------- -- ---------- Remodeling and/or repairing (describe):-------- ------------------------- --------------------------------------••------------------ ----------------- ------ ----------------------------------------------- ''---------------------------------------------------•------------------------------------------------<------- -------- ----------------- - --------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ ----------------------------- --------------------- ------------------------------------------------------------- ---------------=--------------------------------------------------------------------------------- I hereb certifythat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State.laws, and rules and regulations of the San Joaquin Local Health.District. a (Signed) ll = - = - --------------------- 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 IJSE--0-NLY APPLICATION ACCEPTED BY__�1,147i --------.--------------------------------------- `-------- REVIEWED BY-------------------------------- ------- - ----------------- ------ -- --------•--- ---------- ----------------- DATE-----------------------------------------------------------_ BUILDINGPERMIT ISSUED---------- --...------------------------------------------ ----------------•---- ----------- DATE--------------------------------- -------------------.------- Alterationsand/or recommendations:----------------------------------------------------------------------- -------------- ----•--•--------------- ------------------------------------•---•--- ------------ -- ------------------- ------------- -----•--------------------------------------------------------- --------------------- ------------- --------------------------------------------------------------------------------- --------------------------------------•--- ------------------------------------------------------------- I' --------------------- ---------------- - --------------------------------- FINAL INSPECTION BY:f �` �`.r t.( � --- - ------------ Date_j/_.,/--7—� I, �s SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.CQ•