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FOR OFFICE USE: ------------------1�------ Permit No. . ----------- - ------------- - ------------------------- APPLICATION FOR SANITATION PERMIT ------ 1 -------- (Complete plicate) /r ---- ---- --- Cin DuDate Issued -------------------------------- ----- --�---[�'-> -----_.-__ This Permit Expires I 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. This application is made in compliance with County Ordinance No. 549. `JOB ADDRESS AND LOCATION_..--- - 24_ _ ---------•------- -------------------------- Owner s Name--- ---------�--•------•-�d1'.�',�P/1 ------------------------------------ ---------------- ---------- -------------------- ---------------------- ------------=----------------------------------------------- ------ Phone------------------------------------ Address_.. = ----------------------------------------------- ---------------------------------------------------------------.-------------•--------. Contractor's Name--------- t Phone----------------------------------- Installation will serve: Residence P�partment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other E] Number of living units: ----p__ Number of bed rooms 2— Number of baths _ _._.- Lot size __-a..x6 '- '��---------------------- Water Supply: Public system ❑ Community system ❑ Private-&---Depth to Water Table -oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam [DClay ❑ Adobe��ardpan ❑ Previous Application Made: (If yes,date"_--...__...__ ----) No [ New Construction: Yes ❑ No g9--' FHA/VA: Yes ❑ No Et - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi nk: Distance from nearest well-________________Distance from foundation______-________._Material-___...-_______--.----_ __-______--______.__-.-- No. of compartments -------.Size--------------------------------Liquid depth.-------- ---------------CapacitY----------------------- r f Disp 4 Distance from nearest well.,/L .-- -Distance from' Width to nearest lot line___/ ---- Len th of each line--- --�- ------Width of trench_`.. -��------------- Number of lines-.,----�°---''.�-------------�-- 9 i. e Type of filter materia ___ - — _Depth of filter material__/ff'-------------Total length------ _____------------------------ Type __________----------- � If e a e Pit-. Distance to nearest well-Arg) from foundation___�_�-"_-_____.Distance to nearest lot line--. ---Sepg Number of pits--- material-_�_0._�/ ----Size: Diameter—- _.*.�"-----Depth_.. -- tj_____-____---.------ --0 ing .,. Cesspool: Distance from nearest well_________________Distance from foundation----------------_"..Liming Capacity 981s-'Z I ❑ Size: Diameter--------- ----- --------- Depth --------- ---------- - q p Y Distance from nearest building_____________________________ Privy: Distance from nearest well----------------------- -.---- �r ❑ Distance to nearest lot line-- ------ ---------------------------------- ----------------- Remodeling and/or repairing (describe:--------.- -------------= ---------------- i --------- ------------------------------------------------------------- ------- ------------------------------ I ------------------------- ---------- ----- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------ ------------------------------------ (Owner and/or Contractor) ------- ------------ - -------------------------------- -------(Title -------------- ----------------- ---- ------ ---------------- SY=---------------------•-------- ------------•----------- ----- -- -- ) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.. can be placed on reverse side). FOR DEPARTMENT USE ONLY ------ DATE__._ - - APPL1CATlON ACCEPTED BY---__-- --- - ----- '---� ------------ -------------- -�---- 1 ------- ----- DATE-------------- -- ----------------------•------------- ---- REVIEWEDBY------------- --------- -------- ------- --------- ------ ---- ---- _ � --------- ----- DATE--- -- -------- -------------------------- ---------- -- ;; BUILDING PERMIT ISSUED------------------------------ ------------------ - - - - ------------------------------------------------------- 1 Alterations and/or recommendations:. `-s--_..<_ � ------ --------------- " -" -- --- ------------------- - - --------- i Date_.. - -- / tr--------------- ---- ------ --- ---------- ----- FINAL INSPECTION BY:-.---� , ' 19.E ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street. 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.