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F RQFFICE USE: s — ---- -------------- --- ----- J --- (� __ __-_.-------- ___.-- APPLICATION FOR SANITATION PERMIT Permit No. ---/ (Complete in Duplicate) , -- -- --- -- - - - -- 4-:0140--- ----------- -- I 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 N . 549. JOB ADDRESS AND L CATION______ -/> -� 1 -------•-------------------•------------------------ Owner's Name_ - ----- ----. Phone-------------------------------- Address- _ ---------------------------- ------------------ Contractor's Name---- -•-- -- --- --------------- Phone- . / Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: ,o--Number of bedrooms _ _--_ Number of baths ._a2_ Lot size __.41�_4je�1-------------------------- Water Supply: Public system 9�_tommunity system ❑ Private ❑ Depth to Water Table$7.Oft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe dardpan ❑ 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.) 0 ti ` an�C: Distance from nearest well-___-__-___-__-Distance from foundation_-_._-_____-_-___Mater ial--_ -------- ---------- ------------------------- No. of compartments--- -------- ---------Size------------------------- ---Liquid depth---------------- -----._Capacity---------------------- Disposal Fi Distance from nearest well_2 Distance from founclation__,2_4......Distance to nearest lot line----__.._... Number of lines------/---- _- -- __ _-Length of each line---- _4?----__-_-----.Width of trench.R—V--_--___-___.__ _____ Type of filter materia,5> Depth of filter material___-/---3j-__-__-Total length___._,.____________4-P--_�_--_-- Seepage P Distance to nearest well- __ - _yt � _Distanc fou dation__�D_ Distance to nearest lot line-------�__-- Number of pits Lining material_ ize: Diameter__ ��- Depth--.-ate..-------- Cesspool: Distance from nearest well _______________Distance from foundation___------------- -.Lining material--------.___-_--_-____.____-_____- ❑ Size: Diameter- -- -------------- --- ------------Depth--------------- ---------------------------------Liquid Capacity------------- -------------gals. O Privy: Distance from nearest well------------------------------------------ --- ._Distance from nearest building__-- ----------------------------------- 0 ❑ Distance to nearest lot line- --- ------ Remodeling ----Remodeling and/or repairing (describe):------------ ------------------------- ----------------------------------------------------------- ----------- ----- ----------------------------------------- --- .------------------------------------------------------------------------ ---------- ---------- --------------------------------- ----------------- ---------------------------------------------- ------ --------------------•-------------------- ------- --------------------------------------------------- -- - ----------------- -- -- ---------- -------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e laws, :ndjrulesnd r ulations of the San Joaquin Local Health District. (Signed) ------------------------- f n r Contractor) BY --------------------- ---------- ---,- -------- - - (Owner a o - --(Title) - -- - --�- --� ----- - (Plot plan, showing size of lot, location of system in relation to wel uildings, etc., can be placed on verse side). FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY-.---- �-- �Gc�R�------------------------------------------------------------ DATE-----z ------o 4� REVIEWEDBY--------------------------------- ----------------------------------- DATE-- - BUILDING PERMIT ISSUED------ - DATE - Alterations and/or recommendations:--_ ^--_-� - _b 5_-___-----� _- --------- -- -------------- -- ------------------------------- ------------------------------------------------------------------------------- - --- - --------------------------- ---- ------ --------------------------- ----------------------------------- -------------- --- -------------- ------------ ---------------- ----------------- ----- ----------------- --------------- - ---- --- ---------•------- FINAL INSPECTION BY:.----C_ . s -- ---- ------- ------ ------ - Date------- ----- 2 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:elfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.