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�R_OFFICIW USE: ._.¢,e. ¢ APPLICATION FOR SANITATION PERMIT Permit No. -- (Complete in Duplicate) (� This Permit Expires 1 Year From Date Issued Date Issued Applicatioln 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-------- -' ------E,------ --------------------------------------------------------------------- ryOwner's Name------------------ �' --.-.// a - ------------- - --_s � --.7- Address 1 . ------ Contractor's Name------- ------ ----- -- ----------------------------------•----- Phone..'rl� ? �P d Installation will serve: Residence Department House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-___ Number of bedrooms ._?/ Number of baths ---e_ Lot size __ ,r1- __ _fi'-11--------------------=- Water Supply: Public system Communi#y system ❑ Private ❑ Depth to Water Table _&-Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 14�ay ❑ Adobe ❑ Hardpan ❑ Previous Application'Made: llf.yes,date----------------_.-I No /New Construction: Yes ❑ No E+-"FHA/VA: Yes ❑ No [}� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel{---_-------------Distance from foundation--------------------Material------..____._..---___-__._.__________.________. No. of compartments----------------------- Size----------------------------:---Liquid depth------------------ ------ Capacity----------------------- Disposal ield: Distance from nearest"well......_------ Distance from foundation_ ,/_Q__r. __.._.Distance to nearest lot line_f-____._____ 1---------------- --Length of each line----- r� Number of lines-------------- - - g �..�------------..Width of #rench.__�'¢:---------- Type of filter material__._-�'�__4Z� r�epth of filter material___.1y _-_..___Total length------�4�___�p_____________ _ o / Seepage Pit: Distance to nearest well_______________ ___Distance frgm foundation--- ---------Distance to nearest lot line_e��__.____. Number of pits---------1------ --Lining material-_;-? ®_!e -_..Size: Diameter-------3. .+r--Depth....... Cesspool: Distance from nearest well___--------------Distance from foundation--------------------Lining material--------------------__._____________- ❑ Size: Diameter----r- -----=-------------------------Depth----------------- ---------------------------------Liquid Capacity-- -------------------------gals, S Privy: Distance from nearest well____---------------------------------------------Distance from nearest buildinq------------------------------ ---_..._._- ❑ Distance to nearest lot line--------------------------------------------- - -------------------------------------- ------------------- ------------------------------ ---- Remodeling and/or repairing {describey:----- i _ �/-_-r.�------ •��1 £ ------------------------ ---------------•----------------------•-------------------------------------------------------------------------------------------------------------------------------------------------- 1 1 F -----------------------------------------------------------------------------------------------•-----------------------------------------•-------------- -------------------------------------------------------------- --- +� ------------------------------------------------------------------------------------------------------------------------------------- •----------------------------------•-------------z--------- -- --- 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 regulations of the San Joaquin Local Health District. . (Signed)-----------------------------------. �oifs -- and/ar Contractor) By:------------------------- - ----- ------------------------------------- --------(Title----`y ] -------- (Plot plan, showing size of lot, elation to wells, buildin s, etc., can be laced on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- '1---- -- ..; � `- - ---------------------------------------- DATE---------� �� ' REVIEWED BY -------- --------- DATE BUILDING.PERMIT ISSUED--------------------- ---. .: DATE Alterations and/or recommendations: ' / � fJ,� � - --------------------- ------------------•------------------- ----------------------------------------------------------•---------- ------------------------- ---------------------------------------------------------------------•---•--------------------1------------------------------ -----------------------------------------------------•----------- ------ - - --------------------------- -----------•----------------- ------------------------I------------------------------------------------------------ ------------------------------------------ ---------------------- - - ----- ------------------------- ------------------- ------------- ---- ----------------------------- ------------------------------------------------- FINAL INSPECTION BY: rSAN = Date----- X_ -- v--- AQUIN LOCAL HEALTH DISTRICT 1601 E.Haretion Ave, esak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.EO.