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F R OFFICE USE:---------------- z, APPLICATION FOR SANITATION PERMIT Permit No. 1..._. ... 5 (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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.. JOB ADDRESS A D LOCATIOkff4aAf -j-2-- ------��'--_ ----------------------------------------------------------------- Owner'sPhont <-'�fop/. Owner's Name. ------ . ----------------------------------------- ------- ------------ Address--- . .•---- --- ---�' ---- --- - ---------------- `y- --------------------------------------------� Contractor's Name-'71-- Installation Phone =. i _.. Installation will serve: Residence W�<artment House ❑ Commercial ❑ Trailer Court ❑ Mo) o el ElOther ❑ Number of living units: __/--- Number of bedrooms_-_ Number of baths _/--- Lot size --/--f- __ ------ ---•--•----------- Water Supply: Public system E] Community system ❑ Private epth to Water Table b0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ 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.) S c Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- No. of compartments------ rSize---------------------------- Liquid de�--------- ----------------Capacity-•----------------- posarl Distance from nearest well _&-_-_Distaance from foundat�._/j0_______.Distance to nearest lot line______. Number of lines____ _____ _______________ Length of each line---_______�-�___-_��_-Width of trench.-__At ,� 11 Type of filter material_. )Depth of filter material----_/v--------Total length_____________6__Q------------------ Distance _______-___._-_ S pa Distance to nearest well_1�Q�-**-----Distance p from foundation__/99_ ......Distan a to nearest lot line__.'_____ Number of pits_____-_..__.-.__-Lining matenaLk&< A___-_.Size: Diameter___ _ __----__Depth_---,L _______--_._-_ Cesspool: Distance from nearest well---.____-_____-_Distance from foundation_________________.Lining material------------------------------------- 0 _-_----_--______.______-________-❑ Size: Diameter-------------------------------------Depth------ ---------- ----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----_-------------------_----------------_------Distance from nearest building-------------.-------------------.-_----.. ❑ Distance to nearest lot line----------------------------- ------------ ------------•--------------------------•-----------------------------------•-------------------- 7 Remodeling and/or repairing (describe):------- _._ ----- --------- ----- -------------------- __ ------------•-------------------------------------------------•---------- --- ---- ---------------------------------------------•----------------------- 1 - - --------- --------------------------------------- ----------------------------- ''-ems----------- • -- ---------A-4. --------------------•- ----------------•------------------------------ ---•---- ----------------------------------------------------------------------------------------------------- ---- ---------------------•----------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County V ordinances, St�Dte law and rule regulations of the San Joaquin Local ealth District. �, (Signed) A!7 - - -, --- ----�-�---------------- `ead/Aw_Contractor� By:----------------------------------------------------------------------------------- - ---•-- ------ ------- --- .... -- ------- --- ----- (Plot plan, showing size of lot, location of system in relati to wells, buildings, a C., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY---- - l ------------------------------ DATE----- P0, `s------------ REVIEWEDBY------------------------------------- --------------------------------------------------------------- ..... DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------ --------------------------------------------------------------------------------- DATE---------------------------------- -------------------------- 0 p Alterations and/or recommendations:-----------'z74...j�pk----- -------- ------------------------ ---------•----•---------`---------- •-------------------_--------• SL ----------- --- /l__ , c a - e��' .- rC rt—P---_- ------ - ---------�. --.----- . --- -- FINAL INSPECTION BY:- �- - -- /y ------- Date.....-� _ '12 � --.--------------------------------- S 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 F.P.C C.