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FOR OFFICE USE: *JA-,�------- ------------------- 30 -------___------------------- -- APPLICATION`FOR SANITATION PERMIT Permit No. ..l...Q....f7.J�� ' 1- fnS (Complete in Duplicate) �j Date Issued _________________ _______ --.---- --------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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 LO TION_--__--. �______ Owner's Name de Q• - - .- -----------` rPhone------------------------------------ ----------------- Address -------------------=-- t�Address. " '- ------------ -----------------••--------------- Phone •--------=- 'a_ 1-y Contractors Name Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑; ,Other Number of living units:.__- Number of bedrooms_. Number of baths--- Lot size ---- __6 ----- ----------------------------- Water -- ------------------------Water Supply: Public system 2Zommunity system ❑ Private ❑ Depth to Water Table '(01`0-,2ft. ; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand .Loam ❑ Clay Loam ❑ Clay ❑ Jobe Hardpan ❑ Previous Application Mader (If yes,date----------- ------) No UD., New Construction: Yes ❑ No FHA/VA: Yes ❑ No :j TYPE OF INSTALLATION `AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-_-------------Distance from foundation-------------------Material_t__-_-__.__.__.___-..._-______-_-._....________ � of compartments--------------------------Size--------------------------------Liquid depth------------------_..---.�CdpacitY----------------------- is os IlFiel� istance from nearest well..................Distance from foundation-.--------..........Distance to nearest lot line----------------- tuber of lines-----------------------------------Length of each line-----------------------------.Width of frenich___ ---------------------------- e e of filter material--------- Depth of filter materia----------- length-------------------------- w Seepage P istance to nearest well......—-------------Dist ance f m foundation/ _r---__.Di an e°to nearest lot ling--._-_� ___.- Number of ifs___._.____._-----__Linin material-_ _ .b_G_�__.Size: Diameter.' 9 j__-_ r � p j g � '' t c C lS� Distance from nearest well----------- --Distance from foundation--------------------Lining material-------------------------------------- Size: Diameter---------------------- ❑ - ----- -------Depth-- ----- - ---------------------------------Liquid Capaci.tY --------------------gals. Privy: Distance from nearest well----------------------------------------------__Distance from nearest building__i--------------------__----------------- ❑ Distance to nearest lot line------_-------------------- ------------- - I----------------------------- i - Remodeling and/or repairing (describe):-------- ---------------- -------------- ------------------- -------------------------------I-------------- -----------------•-----•---------•--------------••--------------- --------------------------------------------------------------------------------------------------------------- ---------- --- - -- -----_ -- ------------------- - ' --------------------------------------------------------------------------------------------------- ----------------------------------------- . �_ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laves, an"les-and regula+' of the San Joaquin Local Health District. T� (Signed)-------------------- --- -- . ............. . U)- ------------------------------------------'------- (Owner and/or Contractor) -------- --------- - ----------- --- - - - --------------------------------------._Title ( ) --------_-_ --------- By:__(Plot plan. showing size of ocation of system in relation to wells, buildings, etc., can be`placed on reverse side). } FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED:'BY--- _-- ---- -------r - -----------------------------•-------•-------------------- DATE---Z,("_ .-----r------------------------------ ' REVIEWED BY--- " ----------------- ----- ------ ----------- ------------- ----------------------------------------- DATE BUILDING PERMIT ISSUED!----------------------- ----- ----------------------------- DATE------------------------------------------ Alterations and/or recommendations:- :. - I' - ---- =-------------------------------- ---- -------------------------------------------------'---• - --------- ------------------------------------------------------------------------------------ ------------------------------------- -------------------------•--- �i FINAL INSPECTION BY:�. --- -- --'--------- .=----- ---------- -- ----------- Date. `1'._...1._.".-k-------------------------- ij - SAN JOAQUIN LOCAL HEALTH DISTRICT r-` 7 t. _Ni 1401 E.Noxelton Ave.iI 300 West Oak Street `.* 124*Sycamore Street 205 West 91h Street Stockton,California Codi,California j Manteca;California Tracy,California F.Rcq. .j