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FO OFFICE USE: y--------------- --------------------------------- ---------------------------------_--a-_ - APPLICATION FOR SANITATION PERMIT Permit No. ...ZA�____ ---------------- -- --- ------------------- (Complete in Duplicafe) This Permit Expires 1 Year From Date Issued Date Issued Application is hereb jr 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 C�unt rdinance No. 549. G JOB ADDRESS AND LOC ]ON - � -� - ff�w ---------------------------- Owner's Name- ------- ------ -- -- Phone------------------------------------ Address5 --- ---- {-- --------- -------------------------------------------------------------------------------- G 'Contractor's Name----------------- ' � ------ ---- -` - Phone.... Installation will serve: Residence►3--<partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oth'6r'❑ Z Number of living units: __. ___ Number of bedrooms --_Q/kumber of baths /---- Lot size --.sem '�.. _________ Water Supply: Public systemaCommunity system ❑ Private ❑ Depth to Water Tableo ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San Loam E] Clay Loam ❑ lay F-1Adobe ardpan E]Previous Application Made: (If yes,date...._-----__.. -----) No New Construction: Yes No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public-sewer it availeblerwithin.-200_eet.),,' Septic T Distance from nearest well__!T=trn-----Distance from foundation----.__Li quid��1_ M � ria-l- _# No. of compartments_---- _ " ..-. , de, h ! l Capacity-- Disposald: Distance from nearest well,___ --77 Distance from foundation � p.' __.Distance to nearest lot EV Number of lines-------- �.-- _.__--_-Length of each line____ _________ _ _ Width of trench---C;),_ __ 1 Type of filter material----- --- --------Depth of filter material_.__ i .._� Total length-----------_�f'__�---- ---------- Seepage it: Distance to nearest well----- , ` --.___Distance om f ndation_/S-.,-"-_Distance to nearest lot line_•��__..._—� Number of pits------___.........Lining material- 61A-_______-Size: Diameter__ , - ------Depth___ / F Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------- ------------------- �pp ❑ Size: Diameter------ ---- ----------------- - ---------Depth----------------------------------------._.. . Liquid Capacity....------------------------gals. V' Privy: Distance from nearest well-----_- :.- _------------------.--------------Distance from nearest building----------------------------- _--------- ❑ Distance to nearest lot line______________________ ------------------------------------------ ------------------ ---------------------------- Remodeling and/or repairing (describe)------------------- --- -----------------------•--- -----------•--------------- -----------••--•---------------•------------------------- •--------------------------------------------------------- -------------------------------------------------- ---------------------------- ------------------------------------ ---------------------------------•--------------------------------------------------•----•---------------------------------------------------------------------------------------------- ---------------------------------------------------------- --- ------------------------------------•------•---------------------------------------------------------------------------------------------------------- ---- ---- 0 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 't ordinances, Sfate laws, an ru andrruu tions of the San Joaquin Local Health District. (Signed) ---- - ----------- ------------------------ -------------------------- ----(Owner and/or Contractor) + BY: _- -_ ` - �: T----------(Title). - -- �------- --------------------- (Plot plan, showing size of lot, locati n system in relafion to wells, buildings, efc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY _-- --- --, -------------------------------------------- DATE---X ----------------- -------- 1 REVIEWED BY-------------------------- ---- --------------------------------------------- -- -------------------------------------- --- DATE--------------------------- ------------------------- BUILDING PERMIT ISSUED------------------------------------------------------ -- ------------------------------ -- D E or recommendatio Alterations and ns ._ __ / � -t. ....._ro_- -- -`-----�_ ---------------------I------------------------------------------- ---------------------------------------------------------- -------------- - .- y.✓ ..., �-t-....� --------�_ --- ---------------------------------------------------------------------------- � � = --- --------------- - ------------------------------------------------------I------------------------------ - -------------------------------- --------- -------------------------- ------- -------------------•---------------------•- -------------------------------------- -------------------------------------------- FINAL INSPECTION �- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.14aielton Ave. 300 West Oak Street ° } v 1`2q Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California W F.P.Co.