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FOR OFFICE USE: � ------------------ -------------- --------------- - APPLICATION FOR SANITATION PERMIT Permit No. a.�l_.g •- ------------------------ ------- ---- --- --------------- (Complete in`Duplicate) �� Date Issued " t This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal#h District for a permit to construct and install the work herein describe d. This application is made in compliance with C-o-7unty Ordinance No. 549. t P a� 1 ""-------- ----- •-----------------------------------------------•------- --------- --- ADDRESS AND LOCATION , —y//� PQN--------- ------- Owner's Name---- P ----------- ....524._--••------- - �� Address-----------------------�--�------ -✓'/�7 •--. Phone__.-------•---------- -- Contractor's Name----------•-------- ---�-p - ---••---------------- ------- Installation will serve: Residence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / / Lot size ----15-a��---------------•---------•- Number of living units: --t""-_ Number of bedrooms -_f.- Number of baths _� - Water Supply: Public system Community system ❑ Private ❑ Depth fIto Water Table-5-0- Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ I Clay Loam Clay ❑ VA: Yes No ❑ Previous Application Made: (if Yes,date--------------------) No ❑ New Construction: Yes ❑ No [] FHA/ ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: sewer is available within'200 feet.) (No septic tank or cesspool permitted if public �I p}' nk: Distance from nearest well---------------.Distance from founda�(Liquid de--th.MatersaL--_:=_-- Capacity. Size------•------------------ ---- q p p Y = No. of compartments-------------- --- ,i Disposal field: Distance from nearest wel Distance from founda ion_ 4- - -Width ofttrehest loNA) �li�---------------- Number of lines_'------!_--. -- Length of each line_?1._-------- .__ f Type of filter matenal-__'-�._/-- Q� '.._.Depth of filter material-_._ -----------fatal length.__.____�Q--- e l Seepage Pit; Distance to nearest well_.______.__.-_______Distance from foundation---.--_---.-----__.Distance to nearest lot line_________________ "- Depth------------------------------- f Number of pits-'----------- Lining material-------------- ------- ❑ Size: Diameter------------------ - - Cesspool: Distance from nearest well-----------------Distance from foundIttion------------------- Liquiri Capacity --------------------------gals. Dept-h ------------ Size: Diameter --------------------- - -t- +,- ❑ �~ t from neares building .... -------------------- Distance ----- Distance from nearest well --_ -------- -- Privy: _ ------------------------------------------------------- Distance -------- - --- -- ❑ Distance to nearest lot fine---------------------------------- ---------------- 1 -----------, - ------------------------x Remodeling and/or repairing (describe)-------------_----------------------- - ----------------- ----------------------•----------- --------------- ------------------------------ ----------------- ------------------------------------- ----- I ' -----------•----------------------=-------------------- :� ---------------------------------------- ------------ - -------------------------------- ------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the worV.will be done in accordance with San Joaquin County ordinances, ate laws and rules and regulations of t San Joaquin Local Health District. I Q ner and/or Contractor) ----- ----------- ------- ---------- .............. (Signed)---- - -- -- ---- ---- ---- (Title)---- t e (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be place on reverse si e. l FOR DEPARTMENT USE ONLY ! ------ ------ --------- - DATE:-------��=-��'------------------------ APPLICATION ------------ ---- --- APPLICATION ACCEPTED BY------------ ---- ` �- it ---------------- -- DATE------"-----------------•--------------•--------- ----- --- REVIEWED BY---- ---------------------------------- ---- -- ------- - - ---- --------------------- -------------------------------- ----------- --- --- - DATE------------------------------- - -- ---- --------------- BUILDING PERMIT 155UED_---------------------------- ____---_----- Alterations and/or recommendations:-------------------------------------------- -------------------------------------------- --- . ---- Date----- -- --- j � ..._ /('� FINAL INSPECTION BY: ---- I ...._.__�✓.--= - - i SAN JOAQUIN LOCAL HEALTH DISTRICT 160! E.Haxelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California _ Manteca,California Tracy,California Lodi,California F.P.CO.