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FOR OFFICE USE: ------------ -- IM APPLICATION FOR SANITATION PERMIT Permit No. - 1 .. ----- ---------------------------------- ,I- (Complete in Duplicate) - � Date Issued �=""�aZ�--- This Permit Expires 1 Year From Date Issued Application is hereby madel 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, 49. JOB ADDRESS LOCK TIONO �, � � z . ----------------- -- ---- Phon 1 Owner's Name--------- - .l ------� ------- .�'-----------------J-----•�----- ------ =----•---------- - � - - Address" ' -- a `J� --------------------------------------------------- Contractor's ----------------••-•---- -- -•--••---- Contractor's Name Q ------- Phone- r q Installation will serve: Residence []' Apart House mmercial Trailer Court E] Motel El Other Number of living units: - --. Number of bedrooms __-__ "" umber of baths """ "" of size _/� "-------- -- --•-------- ; Water Supply: PWic sys1�. _- /tem ❑ Community system Private0 �epth to W ter Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ No KkdFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION!:AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep Distance from nearest well--- ---------- Distance from foundation-----_--.-------.__Material"""-"_._""-"."..-__""_"""""-""- ------------- ' j --J- No. of compartments--- - - -----------------Size---------------------------- ---Liquid depth----------- --------------Capacity----------------------- a t:o id- Distance from nearest well-'5-- +Distance from foundation""_-�-�----"""Distance to nearest lot line `I / Number of lines---- - ---"-- -"""--- Length of each line "-"""-.."-----.Width of trench--"--<-- - ___/ Type of filter material" Depth of filter material-___ "- ...... otal length""�'"_"""""-"------------- JI � Distance to nearest well--_ _-__Distance from foundation-- Distance to nearest lot ime-_"". T Number of pits--- ---Linin material _"."--_-Size: Diameter' _ "-...--Depth-le, _ __"f-_----------- Ces pool. Distance from nearest well-----------------Distance fro oundation-------------..- .fining material-.-..-.---- -"----..----.----.---_- ❑ Size: Diameter------ ------------------------------ Depth------------- -------------------------------------Liquid Capacity------------------- gals. k 'I Privy: Distance from nearest well--------------------------------------._._- -Distance from nearest building----------------------------------------- F1Distance to nearest lot line-------------------------------- -------------- --------------------------------------------------------------------------------------- ----- I Remodeling and/or repairing (describe) -- - '` ---------------"- --------- --- ---------I--------- --------- ------:----- ------------------ ------ - ----- ----- .a ------------------- I l -mayLe 4— -- ------"---------------------------------------------------------------------- -- - 1 hereby cert--- tha} ' / ------- --------- ------ - I have prepared this application and that the work will be ne in accordance with San Joaquin County ordinances, St s, rid rules�nd regulat'on the San Jaa in Local Health istrict. ` ( ,,,,gig } (Signed ------ � /-Q2 ---�f t----------------------- I v �Con tractor) - - ---- ---- -1 'tai'i (Title)------ --- ----------------------------- - ----- -------------- (Plot plan, showing size of:lot, location of system in relaf' n to wells, ildings, c can be placed on reverse side]. J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - J ------------------ ---------------------------------------- DATE-- ------ - -------------------------- REVIEWEDBY---- -------------11 ---- --------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSN.IED--------------------------------T------------------------------------------------- - DATE----------------' --------------- --- -------- Alterations and/or recommendations: 7 C ` '------- A --- ------------------------ -------------------------------------------------------- -------------- --------- ----------------------------------------------------------- - -_ ---- ----------------------------- 11 - -------------------------------------------- ------------•------------------------------ ------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------- -•-•------------------------------------ - ----- -------------------------- FINAL INSPECTION B�� " , -------- ------------- Date-/ .-- ------ ------ ---- --- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 209 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.ca.