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FOR OFFICE USE: --------- ---- -•---- ----- ------------ __ M t Permit No. r �- APPLICATION FOR SANITATION PERMIT ------------- --------------------------------- ------- ---------------------------- {Complete in Duplicated -off _ G - --- ----- ---- Date Issued ---�"=�------- ------- ------ 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. IYD-5 "7 JOB ADDRESS A D LOCATIONI- --- Phone----- Owner's Nam Address-------- -y�� ---- ------- -------------------------- ---------------- --- Contractor's Name------ i Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel El Other [I Number of baths - _-._�-V----1 Ak--------------------•------------- Number of living units: _1---- Number of bedrooms -.2 � - Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑. Gravel.❑ S ndy Loam Ll Clay Loam El Clay E] Adobe-Hardpan ❑ Previous Application Made: (If yes,date-_--- ------) No New Construction: Yes [:] No � FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ; ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septi an'k Distance from nearest well--_-------------Distance from foundation-_-----_-_---. --Material-----------------_..----_------ .---------_-. I I �� No. of compartments------ -------------------Size----------------------------:---Liquid depth - Capacity - t Disposal :� Distance from nearest well--------------- -Distance from foundation-------------------.Distance to nearest lot line--------------- 6' ❑�� /Number of lines-----------------------------------Length of each line`--------- Width of trench. Type of filter material-------------------- ---Depth of filter material----------------------Total length------------------------------------ ---- �� Distance to nearest lot line__-_-_----. r Seepage Pit / Distance to nearest well-_�-------------Distance ram foundation---.---------------- mf size: Diameter_ Number of pits-. ----------------Lining materia{ - Depth 1 Cesspool: Distance from nearest well-----------------Distance from fc.undation--------------------Lining material---------------- ❑ Size: Diameter-,-----------------------------------Depth----------------------------------- - --------------Liquid Capacity------------•---------------gals. Privy: Distance from;nearest,well-----_.--- .,:------------------------------ ---Distance from nearest building-------------.--------------------------- a - ❑ ----------------------------- -------------- Distance to nearest lot line------------------------------- -------------------------------- - ------------------------- ' � ---------------- r Remodeling and/or repairing {describe):----------------- ------------------------------ ----------------------------------------------------------- - t ---------------------------------------- -------- ----- 1 hereby certify t at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 1 rules d egulati sof the San Joaquin Local Health District. _ � - (Owner and/or Contractor (Signed) ------------------------------- --------- ------------------------ 1 Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY It APPLICATION ACCEPTED BY-.--- --- ----------------- D) -/Ill --��------- I ---- 10 REVIEWED BY--------•------------------------=-- ----- ---- ------------------------------------------------------------•- ------ DATE----- -- ----------------------------------------------------- -- BUILDING PERMIT ISSUED----- `------------ -4; -- --- ------ ------- ------ --------------- Alterations and/or recommendations:__..--..-�..--._--.11---------------- -4- - --- ---------- ------------- ---------- ..'---- -- --- --------- .k----------------------------•- --- -" = Date---- - ----------- �- -----------------------�- FINAL INSPECTION BY:... ----- -- --- - - - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. j 300 West Oak Street 124 sycamore street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California $7.P.cn.