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FOR OFFICE USE: _(' 'A APPLICATION FOR SANITATION PERMIT Permit No. 2. .. 0 __ (Complete in Duplicate) f��}} `t Date Issued `�C--!�'t_V___ 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. �"-------------------------- r` `'--------------------- ------------------------------------------------- Owner's ------------------------------------ JOB ADDRESS AND LOCATION----------------------------------------------- --------- ;1 lig:'r`f ig^ �� ------------------ Phone--"/.-. ` �.='-.4;--A- Owner s Name ----•----------•----•-----------------•- ------------------ - - Address------------ =.....-•----. `�_ '-� 1 '---------------=•------------_---- Contractor's Name---------_----•-s==^F-/ ----------•---_- ------------------ -------------- ••---- Phone----------------------------------- Installation will serve: Residence ffr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __(___ Number of bedrooms __--4 . Number of baths ........ Lot size - �f X_. _C' ____________________________ Water Supply: Public system 2' Community system ❑ Private ❑ Depth to Water Table A�bft. 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 [3"� New Construction: Yes 2'�No ❑ FHA/VA: Yes ❑ No n TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f rv' f Septf'' TT nk: Distance from nearest Distance from foundation--------------------Mateyial------A_<`-�--------------_.:,,__., LJ No. of compartments-.________;•2—---------Size-1_�_�S-_----_`�-----------/ Liquid depth---tl--------_.-------Capacity....:��(T Disposal Field: Distance from nearest Distance from foundation....... Q_--------Distance to nearest lot line____,,........ Number of lines------------- -------------.------Length of eachline_`_"_-'-_�'_'= �'-___.Width of trench__ %_`-------------------- O Type of filter materials!') t_.fcisf�Depth of filter material------L-f____-__Total length___--___7_+^--------------------------- . v/ Seepage,Pit: Distance to nearest well_____--:='__-_..____Distance from foundation___________________.Distance to nearest lot line-,----_s---------r � . Number of pits_______________.Lining mate ria l__rl_d`.1�.______Size: Diameter___=-'�3..'----------Depth-----..r%S.__'___________.___ Cesspool: Distance from nearest well-----------------Distance from foundation------------------..Lining material--------------------------.-_.____-- ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------.------gals. Privy: Distance from nearest well __.----------------------------------_------__Distance from nearest building---_______-.-___________________-__. ❑ Distance to nearest lot line------------------------------------- ---------------------------------------------------------------------------- ------------------------- Remodelingand/or repairing (describe)----------- ------------------------------------------••-•--------•------------------------- ---------- --------•----------••------•----•------------ i --------------------------------------•------------•---------------------------------------------------------•------------------------------------------------ -=----------------•--------••-------------------------------- ------------------------ ----------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------- ---- ---------- --------- --------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this appli ation and that he work will be done in accordance with San Joaquin County ordinances, State laws- and Jules and regulations the San Jpa n Local Health District. _ Vim= `r' ►rte /a`= --------------------- --------------------------------------(Owner and/or Contractor) (Signed) By:---------------------------------------------------- ---------------------------------------------------------------------------(Title)--------- -------------------------------- - - --- - ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- -- ----------------------- ------------------------------------------ DATE---- --- ��'� --- .._4 ,,/ REVIEWEDBY------------------------------------------ ---------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED--_--------------- --------------------------------------------------- ------ DATE--------- --------------------------------------------------- Alt rations and ec mmendatio s:----- cl' - - - -- -- -- -- - - ----------- ---- --- . ---- --�� .......... / ---------- - ------- ------------------ ----------------------- -------------------------------- ------------------------------------ ----------- -- -- ----, --- -- ----------------------------------------------------------------------------- ' -- ----------- ----------------------------------- ----- ------ -------- ------- ----------------------------------------------- -- FINAL INSPECTION BY--------------- - --------------------------- ---------- Date-------'-S-{--'-`!�/�� ------------------------------------------- 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