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FOR OFFICE USE: - I d, _.__...._ .._ --------------------------1I --.-. APPLICATIQN F SANITATION PERMIT Permit No. 1 ........ - - --- -- -I� (Complete in Duplicate) -------- ------------------------------------- -------- --------------------------- II� This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Heaifh District for a permit to construct and install the work herein described. This application is made iriicompliance with County Ordinance No. 549. w�J b r� ASO JOB ADDRESS L CATION/-{7XV / 1II Owner's Name `` ! . Phone Address-------------- '�I - ` -a ------- ----- ------ ------------------------ ----------------------- ----------------- ----------------------------------------------- Contractor's Name -------------------------------•-----------------------------------•----•--------------- Phone---------------------------------- Installation .----------------•---------- - Installation will serve: Res.Ip idence QI_Kp�artment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other El Number of living units: _______/Number of bedroom Number of baths _� Lot size ---- ______________ --- --- Water Supply: Public system ❑ Community system ❑ Private Depth to ater Table _`Jc}ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Cla _--Adobe E❑ Hardpan (]� Previous Application Madel If es,date---------------- PP � I Y ----) No ❑ New Construction: Yes 1111<01,E] FHA/VA: Yes C17/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: —(No septic-tank-or-cesspobl permitted-if public se'wer'is available within 200 feet.) Septic Tar: • ` Distancl� from nearest well__�__�____Distance from foundation----/U__.__._ Material -- - ._____-. No. of Vicom artlmen#s__ Size____ y__ -----------------Li uid de th____.!/ P - ------ --I— q � ? ----------------Capacity-�- � Dis osal F' Distance from nearest well._�._..._.Distance from foundation_____ Distance to nearest lot line___ i p 1 I �r Number of lines_.:._____ .t Length of each line of trench___.�_�------_------------- Type of. filter ma#erial____l--(�___ Depth of filter material____- :_ Tota4, len th_---- - ------ ------------- Seepage Pit: Distance to nearest well_____-----------------Distance from foundation_____..__________.Distance to nearest lot line---- F1 � ❑ Number of pits--- Lining material--------------------- --Size: Diameter----.------------ - ---Depth--------------------------------- Cesspool: Distance from nearest well ___________ __Distance from foundation__-------------.___.Lining material_____________.______.__--__________. ❑ Size: Qiameter - Depthi Liquid Capacity ------------gals. Privy: Distance from nearest ,welf-----i__-----------------------------------;....Distance from nearest building.____._______..________--_-------_-_-----. 4� ❑ Distance to nearest lot'line---------------------------------- Remodeling and/or repairi .g (describe}:....___..z.__ ___ _„� P , --------- -•------------------------------- ----------------------------------------- ---------------------------------.-------- --- i� i . . .-. ordinances, certate fy that at I'Iha es r p---e ---I ti sof theSana Joaquin Local Health District.___.____'___ ____ ___________ __q__ - _y have re ared this a lication and-that the work will"'be`done in accordance with San Joaquin Count i l t (Signed)-------------- ------ - -;------- ------------ ----------- -- --------------------- ---- (Owner and/or Contractor _ 6 _ By -- _ -- �r- _- _�..•. ----- {Tifle)' Plot plan, showing size of 1 tion of system in relation to well s ( p 9 y s, ui Ings, a#c., can be placed on reverse side). t �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDIp BY S �Gt _�� DATE____�!_.��_____ ------------ --- -- - - - - - - - REVIEWEDBY------------------ -l� - fi --------- ------------------------------------------------------'-•--- DATE-----J BUILDING PERMIT ISSUED!k------------------=------------ ---------- ---- - - ---------------=------- - ---------- DATE----------- Alterations and/or recommendations:____': --------------------•------------------------•---------------------------- ------------------- -------------- - --------------------- - -------------------- ----------------------------------------- %----------- ----------•--------- --------------------------------------------- ------------------ -------=-------------------III--------------------------------------------------•--------------------- -------------------- •----------- -------------------------------------------- ----------------- -----• - ------------------ -------- - • ---------------- ---------------- ------------------- -- ........ ---=- --------- ------------------- ............ --------- ----------- -- -------------------- ----------------------------- --------------------------------- -------------------------- FINAL INSPECTION BY . -------------- -------------------------- -- "SAN.JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California � _ }� Manteca,California Tracy,California _ F.P.Cq.