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FUR OFFICE USE: y r V 'z 3- J APPLICATION FOR SANITATION PERMIT Permit No.,....------------------------------- —� (Complete VDuplica+e), This Permit Ex !res'1 Yeah rFTom:Date Issued Date'"Issu j Appl'icafion is hereby made to the San Joaquin Local Health District for a permit to construct and install'�h"e work herein described. This application is made in compliance with County Ordinance No. 549 f OB ADDRESS AN O ON J ---- -( ---••------- ---- ---z---•----- -._Phone.. Owner's Name----------- --e---•---•�--`--_--- -- i Address------------------- k , I ------- `------- #.. Contractor's Name------------•---�--------•-----------•----- pL � 1 - -- -• ---- .. i u-- ! : lPhone_ Insfall8fion will serve: Residence �artment House CO0 mmerci ❑ Trailer�Caurt ❑ Motel ❑ Other Number of livingunits! '�N fiber of bedrooms ❑ •-- t�: Number of baths _ Lot�size' '�--_..�,�Q._Z�„-•-•_-.---.•_ Water Supply: Public systeM 1 Community system ❑ Private ❑ Depth to Water Table-S.7P-__ ft� 'I Character of soil to a depth of 3 fee+: Sand ❑ Gravel [! Sandy Loam ❑ Clay Loam ❑ Clayo' Adobe[ hardpan ❑ Previous Application Made: (If yes, No No ❑ New Construction: Yes ❑ No [R �FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONSc F f (No septic tank or cesspool permitted if public sewer is available within 200 feet.} pti ank, Distance from nearest well________________Distance from foundation_____:-.:____...___.Mater.iel:.:_ '_.__...__-_-_- i , -No. of compartments-------- I .: ......................... i q gyp. -----= p Size--..----•---------------- ---- Li Liquid de th...__<:'__..._ ._ Ca au p igld: Distance from nearest well-----------------Distance from foundation...._:::. Distance to nearest lot line................. Number-8f. P ber-of lines-----••-=`-- Length of each l�net--.-----•---------- Width of ttrenCh__. T e of filter material__________________ _____ s I - _De th of filter material--------------------•--Total length---•.-•---------=-••--------•---•-------.. Seepage Pit: Distance to nearest welE _Dista om foundation ... .... scan veto nearest lot iine. .Q-_. .-. Number of pits_- __/_____________Lining maferia�_}4�---Size: Diameter..., --------_ Cesspool: Distance from nearest well________________ Distance from foundation.--._._...____.-__.lining material_...........:I------------------------ ------- ❑ Size: Diameter--- --------- •---------Depth------------------- -- -- - .Li Liquid Capacity is Priv - - - - -------------- - q � P �ty-�..---- g # - � ------------------- ala. ' Privy: Distance from 'nearest well--__------_[- -�_-_-_- ------_------- Distance from nearest building______________ __ 1 ❑ Distance to nearest lot line.-___.._- - Remodeling and/or repairing (describe)_ -----------------_-----s.------------------- I ----- =----------•--------...----•-------•.•----••---•-•-•-------•-••-•-•--•--•--••----••- 1 ----•----I I ------------- - - I = '•--------•-••-•-------••-----------------=-------•---------------- I here cert y that I have prepared this application and that the work'will be !lone in accordance with San Joaquin County ordinance at aws, and r les and�pg:ulations of the San Joaquin Local Health District. (Signed)_ = f �- -------------- i -(Title)... ., --• -- ner and oa Contractor) By------------------•-------'----------. - p (Plot plan, showing size of lot, l�cation of system in relation to walls i din s, etc., can be laced on reverse side). E __ _____ APPLICATION ACCEPTED BY--------- REVIEWED -_--- DATE_____--__ gip._--.-- _ -----------••------------- 1 REVIEWED BY -----•----- ------------------- - -----r-• - : - ---. �� - - ---------•-------------------------•------------ DATE------...-------•- •- - ---.. BUILDING PERMIT ISS'UED------- ,' t - ------ ••-----------•--------- / - -•- ----` \----------------------------------- DATE---- I / / , �. t ti AIle tion and/or recommendations:___._._.__ l � _ - ---••-----------••-- �n -------------- C(l - ---------------------- f=------- --------------------------------- FINAL INSPECTION :B --- ---- ------ --- --- '- ------- Date...----- int-- -•- -------------••---------• SAN JOAQUIN LOCAL HEALTH DISTRICT gib. 130 South American street .360 Went Oak Street 124 Sycamore street 205 West 91h street E8 9 REVISED $-59 8M 3-411 ATLAS Stockton,California todl,California Manteca,California Tracy,California •. r