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FOR OFFICE USE: Iflyl _. � APPLICATION FOR SANITATION PERMIT Permit No. ................... - .. . - - = ------------------ ---------------- (Complete in Duplicate) Date issued Z __ --------------------------------------------------_ ... 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. This application is made in compliance with County Ordinance No.'549. a 2 3 moi. ----------------------------------------- JOBADDRESS AND LOCATI N----�--------- -------------•---: � -------------------- � ---------------- ----------------•------------ Owner's Name-- Phone Q--------------•---•- k Address Ss3 g �. ----------- ---Z---------------------- •-------------------=---------------------------------- ----------------------------------------------- Contractor's Name--- ' 7 i Phone. Installation will serve: Residence [ Apartmen�Houso ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of bedrooms ._�_ S.S` x 3 Number of living units: ..-1 . ._ Number of baths Z•.-. Lot size _____.._______.-----�--•---- ----------•-------------- Water Supply: Public system Community system [] Private ❑ Depth to Water Table ------._ ft. Character of soil to a depth of 3 feet: Sand F]' Gravel ❑ Sandy Loam El Clay Loam El Clay dobe❑ Hardpan ❑ I Pre ous Application Made: (If yes,date-.x.................I No � New Construction: Yes [[>�No El FHA/VA: Yes ❑ No C� TYPE' F INSTALLATION AND SPECIFICATIONS: jNo septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T�k: Distance from nearest well-�"....___Distance from foundafior6?-A--------------Materia ------------- --------- _.-..--... r No. of compartments......s'L---------- Size--- J�.. x.�---.---Liquid depth---'�-- -----Capacity---_---p - Disposal Field' Distance from nearest well---"`-___..-Distance from foundation__A� o__......-Distance to nearest lot line-6---- [ 4ANumber of lines-- _ -------------` -____ D ---------'Length of each line.�6�.`= f7-.-___.-.Width of trench_�� -4----------------_------ -- . p e th of�filter materiallEr-----------------Total length-.-/ --------------------------- .Type of filte�pmateria` c' __ I r Seepage Pit: '' Distance toy nearest well..----------...Distance from foundation.s?p._`....__. Distance to nearest lot line-1................. Q `� ........... - k Cesspool: Distance from nearest well-----------------Distance from foundation.........-----------Lining material---------------------------------- -.. ul F1Size:,Diameter-------------------------- ------Depth-------I---------------------- ---------------------Liquid Capacity-.-------------------------gals. �. Privy: Distance-from nearest well---------------------------------------------- --Distance from nearest building...-._____.____.__.__._____--------__-_--. ❑ l Distance to nearest lot line:---------`-- .---------------------------------- -----------------•----------------------------------- --------•-------- ----------- Remodeling and/or repairing (desu2 cribe):--------------------------------- ----------j�---------------------- -------------------------- ----------------------------------------------- ---- ----------- -------------------------------I------------------------------------------------------------kF ----------------------------------------------------------- ------------ -------------------------- - --------- ----------------------------------------t------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and r gulations of the San Joaquin Local Health District. y t. -------------- --•--------- --------)G*wrev=ax: ,/or Contractor) II .. .............. By:-----------:--------------------------------------------------------------------------------------------------------------------- ----(Title)_ ----- ------------- [ e k (Plot plan, showing size of lac, location a# system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY a r _ APPLICATION ACCEPTED BYa -_ ------ - -`------------------------------------- DATE__//-_` ----------------------------- -- I. - --- -----------------`-------------------------------------- DATE------------------ ----------------------------- BUILDNG ERM.IT ISSUED--------------- ---------------- ----------- DATE I ------------------------------------------------------------ ' ---------- ----------------------- Alterations and/or recommendations A.--- 5-..�y_ .. ' ��----- - ------------------------------------ ------------------------------------------------------------------------------------ ------------------------------------------ --------------------•--- ----------------- --------- -------------- ------------------------------- ---- - ---- ------------------ ---- ------- i------- FINAL INSPECTION BY:.... �i� ------------------------------------- J SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C 17.