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FOR OFFICE USE; it --------------- ' _ -- ----------------- ------------ ----- -- -------------- . - APPLICATION FOR SANITATION PERMIT Permit No. I .-__.----------------------------------------------.. * {Complete in Duplicate) - Date Issued b' 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 applicatgion is made in compliance with County Ordinance No. 549. F I.. � ------ = ---- ewA - . JOB ADDRESS AND OCATkON__ _ _ . Owner's Name---------- - -- ----- -------•------: • --- . ------ ------------- Phone Address-------4?4 •--- -- -------- - f------------------------------------------------------•------------ ---------------------- - Contractor s Name--- ----- - Phone Installation will serve: Residence ❑_.Apartment House ❑ Commercial ; Trailer Court ❑ Motel ❑ Other ❑ Number of living units: °~'-- Number of bedrooms Number of baths `---- Lot size 49164:�� ------------------------------- Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Tabla.-e ft. Character f f soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ug�'<rdpan ❑ Previous Application Made: (If yes,date-._--__.T-_.__=_..) No New Construction: Yes �o ❑ FHA/VA: Yes ❑ No 9 TYPE OF INSTALLATION AND SPECIFICATIONS-* s (No septic tank or,icesspool permitted if public sewer is available within 204 feet.) ce from nearest well_AAe._.Distance from foundation-_1/0_-1/0 -.-.Mat�il_ ' Septic _ �f ---_--__-_ ---._-. Ile' Distance compartments-A--.-._..-r......-.SizQII�_ . __Liquid depth_.- ... . -- --____Capacity.� �_.__-.--- 00 Disposal Field: Distanlce from nearest well- �_Distance from foundation- --ei Distance to nearest lot line za.. .� Len th of each line__ __ Numl7 r of lines-------- ` g ee__!----�----.Width of trench- --------------------- Type lof filter material G Depth of filter materiaL_ZOP--- --- Total length__ --------------------------- Seepage Pit: Distar%ce to nearest we€l-------------,-------Distance from foundation---==----------------Distance to nearest lot line_____-_-____---- ❑ Number of pits----------------------Lining material-----------------------SILO: Diameter-------------------.---Depth-----.-.------------------------- ) Cesspool: Size:ool: Distance ' l- 'from nearest wel ________________Distance from foundation----------.---------Lining material_ _ .___-"_ ----------------_-------- Qiarjleter -- -- - - ------------ ---- -- Depth------------------ --- -----------------------------Liquid Capacity----------------- -------gals. Privy: Distance from nearest well.-..-----.-. __________________________Distance from nearest building------_.____---_-_-----_------..-...___._. ❑ Distance to nearest,lot line ------------------------------- ---------------------- ------------------------------------------------ -------------------- -- -. Remodeling and/or repairing (describe): .... �___ ____ _ ---- -------• -------- ---- -------'- --- - --- - •� - ------------------ '� --��---------------------------- -------- ------------- -----------------------------------------------•------------------------------------------- -----:---------------------;------------------------------------------------------------------- ------- - I hereby certify that;I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r ulations-of t San J aquin Local Health District. ---- ---------------------- ----- Contrac � <. (Signed)------------------------ /or tor) BY:------------------------ -' ------------------------------------------------- - -- ------{Title) ----------------------- ' (Plot plan, showing size of lot, location of system in relati o wells, buildings, etc., can be placed on reverse side). I I! FOR DEPARTMENT USE ONLY, t DATE U--------- ----------- ---- a ` , �a 5 APPLICATION ACCEPTED BY.: ^-- --- -------------------------- to REVIEWEDBY-------------- �------------------ - -------------------------------------------------------------- --- DATE_ ?,..-"------ BUILDINGPERMIT ISSUED--l'---------------------------------------------- ------------------------•=�,- ------------------- DATE------------------------------------------------------------ Alterations and/or recommerihdations:-------------- --- ---- -------------------- --•-•---------y-------------•-------------------------------------------- --------------------------------------- _ __---------------------------------------------------------------------------------------------------- S II l I ____________--------------------------------------------'------.------------.------._------------ --------_----------------------------_______!_.__..------------------------------ ------------------------------------ .._-.-__._____.______.___._._...._.__.______ .----- ---------------b-------------------- -Y FINAL INSPECTION BY:._' 'll ' _ I f I-- ---.. . --- - -•- --------- ---- ---------- Date-------- ��-----�------`��--• - - -----------------'�-�------ SAN JOAQUIN LOCAL HEALTH DISTRICT s 1601 E.Hazelton Avo. , 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ° Manteca,California %' Tracy,California {'s F.P.EO. , !I