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0 FOR OFF19E,USE: -------- --------- ---------------4-- --- --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------_------------------- (Complete in Duplicate) -----------------------------—---------------- Date Issued 3 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 in all the work betel descrbed, This application is ma�dWl compliance wit County Ordinance No. 49 y -V JB UD fE S S AND TION dQ �Gb / `' = -- ---------- .. .. Owner's Name----- M- A.P_------------- -------- ------ ------------------ ---- -------- Phone------- -------------------------- ------------- Address -------------- ------------------------ - -- - ---------- --------- ------------------------------------------------------------------------ - Contractor's Name--- --------- ---------- ------------------------------------------------------------------------------------ Phone----•----- ------------------------ Installation will serve: Residence L?"*Ararfmenf House E] Commercial [] Trailer Court E] Motel 0 Other El Number of living units: ___ _._ Nu r of bed`r�ooms2_--Number of baths ---- Lot size Water Supply: Public system EjLlMnity system E] Private E] Depth to Water TableA""'ft- Character of soil to a depth of 3 feet: Sand 0 Gravel [- I S Loam E] Clay LoamEl E]lay Adobe E+-11—ardpan F] 4' Previous Application Made: (If yes,date____________________} No t�>Ne, Construction: Yes , E] FHA/VA. Yes El No,E�1� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic TInk: D•stance from nearest well___,_�-- Distance fro�n flundafion--/-d--------- --------- ly -Liquid depjh-------!7/� No'. of compartments---------- —-------------S;7e__%.X_ a----- -------Capacity---- --q-a;------ Disposal Field: Distance from nearest Distance from foundation---j0_1------Distance to nearest lot lines ___.______Number of lines---------I-----------------------Length of each hne_'�W --------------Width of trench-.PY'A----------------- Type of-filter maferiaI__).)'-L---_--------Depth of filter rriaferial--- --------Total length-- _f . 1 7- - - 7-—-----------------I.,--------- Seep if: Distance to nearest w --_-____Distance from foundation- )c I �istance to nearest lot line�?.,__ Number of pifs- -------- -y--'size: LME -------- ___..Depth____-;�_JiZ ---------- Cesspool: Distance from nearest weil------------------Distance from foundation ---------------Lining material________.._______ __________ -------_ F-1 Size: Diameter--------------------- ----------------Depf h----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--_-____.__________ _____________---___---_ -Distance from nearest building-------------- Distance to nearest lot I;ne------------------------------------------------ ------------------- Remodeling and/or re'p8iring (describe):------------------------ r --------------- -----------------------------------;-----------------------------------------------------------------------------------------------------------------------------------------------;�------------------------------------- ------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------- ----------------------------------- -------------------------------:--------------------------------------------------------------------------------------------------------------------------------------------I-------------- I hereby certify that I have re ared this application and that the he work will be done in accordance with San Joaquin County ordinances, Sle�ws, and rul s an gula ' he San Joaquin Local Health District. W lions of f (Signed)----=- - -- ------------- - - - --- ----- ------- -- ------- --- ------ ------------------------------------------- .........g\ ------(Owner and/or Contractor) By:--:-- ------------- -- - ----- ----- -- - -- -- -- -- - ------ - -- --------- ------------------------------- ------------ (Plot plan, showing, ize f lot,location of system in relation owe s, buildings, etc., can be placed on reverse side). FOR.D9ARTMEN"SE ONLY APPLICATION ACCEPTED - - --------- DATE,,-X-- -- ------------------ ---------- REVIEWED- BY--------•------------------ ------- -------------------------- DATE-------- -- ------- ----- F BUILDING PERMIT ISSUED-------------- ---- ..... ---------------------------- a i n ------—------------------------- --------- -- Alterations -- --------------------------------------- Alfer'fio s and/or recommendations:---7 Y17" --- --------------------------------------------------- ------ -----------------------------------------------------------------------_----------------------- ------------------------- ----------------------------------7-------------------------------------------------------- ---------------------------------------------------4------------------------------------------------ ------------- - -------------------------- ---------------------------------- ---------- -------------------------- ----------- -----------------------------------------------------11--------------------- ------- ---------- ----------------- ---------------------------------------------------------------------- -------------------------- --------------- ------------------- ------ --- ----- -- ----------- ---------------I---- --- ------ -------------- -- ---- -------------------------------- -------- FINAL INSPECTION' ...... B ..... --- - ----- ate------- ---- ---- ------ SAN JOAQ LOCAL H LTH DISTRICT 1601 E.Hazelton Ave. 300 Was Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED E-59 3M 3`63 07.P.120.