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Fpy OFFICE USE: ... ------- - .. - _ Permit No. - � APPLICATION FOR SANITATION PERMIT in pu llcate /? _.' :%D"' (Complete P Date Issued 1--_ -------.------ ----:----------------- ---- 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. 1 (d This pi ppli t�i�ri�ls adrq �complian th C my rdypar flo 4P2 ��'' (�3 - � f _ I VT JOB ADDRESS AND LOCATION_ _ Owner _ i, ------- Phone--------------------------------- ------------------------ --------------------------- Add ess-..--- - •-�' ----- - - �� -1.---� - ------------------------------------------------------ '- ------------------------------------•- Contractor's Name_.— Phone----------------•------••---- --------- Installation will serve: Residence`` t,�Apartment House ❑ Commercial E] Trailer Court ❑ Metal ❑ Other El Number of living units: _-/..- Number of bedrooms �.?---.- Number of baths AZ... Lot size -- 4 --•-------------------- Water Supply: Public system [I Community system El Private epth to Water Table aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Loam F1 Clay Loam ❑ -Clay ❑ Adobe[ rdpan F1 yl Previous Application Made: (If yes,date_--_---------------) No [j-'-New Construction; Yes 2'*-N6 El FHA/VA: Yes R�-- No ❑ .' TYPE OF INSTALLATION AND SPECIFICATIONS: �+ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ._.Mate ial._. _ � - / 49---- 3 Sept�c,Tank: Distance from nearest well__ ----_Distance from foundation__. Nn. of compartments.... ----------------SizeF'.-- - _ ..Liquid depth--- --------.Capacity__ Q.rl__----- -' r ! / li ' l ------ Distance to nearest lot ne_ p_____. ,Disposal Field: Distance from nearest weiL_. �__--.._.Distance from foundation.._ __ Id' Number of lines___._a ___.___�-.- ----- Length of each line.__ c /___.-- -_----Width of trench. :_ �__________________.. e th of filter material _/ __. Total length__ _-_-'--------------- I� Type of filter material--x;. p < -_-_ istance to nearest lot �me_f ._.__ See^pag'e Pit: Distance to nearest well___��__--Distance fr m foundation_____��- � � - 1 Number of pifs_-_,p?------------Lining material- 1 ----Size: Diameter - --------- ----Deptoo '__ ---- ---- rr�,,,, Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material-------------------.---.._____--al-- VS - Li a ❑ Size: Diameter.--- ---------- ------- --- --�-Dept�hF.--------w= -- ------ ------ G uid Capacity_-------------------------Yg ! Privy: Distance from nearest well--------------------------------------------- --Distance from nearest building-------------.-------______ _ ❑ Distance to nearest lot line----- ---------...- ;Z�v------------ - Remodeling and/or repairing (describe):- ------------AW - • -+---------*----�--�--_-------- - ----------------------------------------------------- In -------------------------------------------- ------------ - - -------------------- ------ --- ------------------------ = ----------------- -- I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County c ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Cp ✓ ------------------------( ontract orj - - -------------- - (Signed) ------- F I --------- --- - - -- ---- By:------ -- {Tl+e) (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_-__-.__ ----------------- -`-- --------------- ---------------------------------------------------- -- REVIEWEDBY-------------------------------------------- --------------------- ------- -------------------------------------------------- DATE------------- -------------------------------------- _ BUILDINGPERMIT ISSUED---------- --------------------------------------------------- ------------. DATE----------------- --------------------------- --------------. Alterations and/or r commendafions--------------°----- --- - ------------ ---- --------------------------------------•--------•---------------------- "14 '------------------------------------------------------------ ------------------- s --- -- -------------- ------------------------ ' -- �-- --------------- l y � - Date---------- ---------------- ----------- --------------- ------------ FINAL INSPECTION BY:....... ---------- - -------------------------- " .711 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3oo West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California