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rum urrlCt USE: -��-� - ------------ ------------------ �! APPLICATION FOR SANITATION PERMITPermit No. ... l..?.. .... !_ (Complete in Duplicate) - --------- - — ----------- ------ J This Permit Expires 1 Year From Date Issued Date Issued -_ /._-_ __•�?� Application is hereby made to the San Joaquin Local Heal t District for a permit to construct an all the work herein described. This application is made in compli ice with county /Ordi ce 549 JOB ADDRESS A D OCATIO _-•____�OZ /• ----- -- wner's Name________ - - - -------- ----- Address------------------- ----• Il . --------- ---------- _ - - -- ------ --------- ---- --- ------------------------------------------------------ Contractor's Name__ 4 Phone e4. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ N er of bedrooms __�___ Number4�f baths J--_ Lot size ...Ie__�_ .« ` /,__,, Wafer Supply: Public system Community system E] Private E] Depth to Water Table __&A- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ e 0--- and an . m p ❑ Previous Application Made: (If yes,date_-_____ -_____-) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE,,RF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within200 feet.) S Distance from nearest well____ __ __Distance from foundation •- -•---•-----_,Material------------------------------------------------- No. of compartments-------- Size. ------------ ---Liquid depth Capacity f s Distance from near st well.__.____O-__ Distance from foundation-_!�_f l _-___.Distance to nearest lot line_____. f Number of lines_________ `_._. Length of each line _ __ - K !-- - --.Width of trench_- ---__ Type of filter mater _- _.__.__________Depth of filter material__,�,f�-�fotal length------------- _.__®_--------------- � Seepage Pit: Distance to nearest well______________ _______Distance from foundation-------------------- to nearest lot line__-___.-_._.___.. ❑ Number of Pits----------------------Lining material._______-___.______-Size: Diameter___-___._._ --------Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------- material__.___.-_. ❑ Size: Diameter- - Depth - -- - --------------------- -----------------Capacity-.--------------------------Privy: Dista from nearest building Y ❑ Distance to nearest lot line_____ -- __._______-____ _ _ _ _ •---- -- ---- ---------------- Remodeling and/or repairing e)c-------_ __ ----------------------------------- ........................ ----------- ------------ ----- ------------------------------------------- ---------�ee4� -------------------------------------------------------------- - ---------- ---- ------- ------ ------ ----- -- ----- -- - --- -- ----------------- ----- --- -- - --- ----- I hereby r ' y th I have prepared this application and that thew will be done in accordance with San Joaquin County ordinances, aws nd rule and ulations the S Jo uin al Health District. (Signed_ ---------------- ---- ---- - --- - ---- ----- - -- -- -- ------ --------------------------------- ,Les BY�------------------------------------------------------------------------------ (Title) Contractor) -- --------- ------ - ---( � )------------- (Plot plan, showing size of-lot, location of system in re io to we s, buildings, tc., can be placed on reverse side). FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY______ - -------------- ------ DATE_____7-=—`�_ - -3_- ------------------ VIEWED BY ---------------------------- ---------------- ----------------------- ----------------------------------------------- DATE------------•---- BUILDING PERMIT ISSUED ----------------------------------------- = ------------------ Alterations and/or recommendations:___________________________ FINAL INSPECTION BY:.... _. � _ ------------------ ------ Date----- `r '�:..1!---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California