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FOR OFFICE USE: `. -a =� --------------------3:3-_ _-- /tea APPLICATION •FOR SANITATION PERMIT Permit No. ................ --------------------- -- (Complete in Duplicate) 0--- - ----------�.l 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 AN LOCATION--- �� ------- �'``'` ---------------------------------- JOB ADDRESS Name-__ . __ Phone- Address.. __ �... . 1Lr? --------- Phone Address... 1�v�.. .. - . Contractor's Name---------. _a_ ��D. L�r¢----- - -tit---- - -- _- Phone._/7 _ _ ._ _p` Installation will serve: Residence ��,r Appaartment Hous�Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ �l Number of living units: __ _ Number of bedrooms . -. Number of baths.____ Lot size -____-- __ ._j __--__--_--___.__ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablett lft. 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 x Naw Construction: Yes ❑ No k FHANA: Yes ❑ No X ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:r /VGDistance from nearest well----------------- from foundation------------------- Material_________________________________________________ ❑ No. of compartments-- - - ------ - ---------Size------------------ ------ -----•Liquid depth---------- ----- ---------Capacity------------------- Disposal Figld:�.ip/Csfance from nearest well--------------- -Distance from foundation--------------------Distance to nearest lot line----------------- [❑ 0C �� Number of lines-----------------------------------Length of each line----------------------------..Width of french-------------------.._-------------- Type of filter material-----------------____.__Depth of filter material---_.___.---_________Total length--_-__..________-________________________- See age Pit: Distance to nearest well.-.141-97-- Distance f om� --- DIS to nearest lot line_.' -__-_. Number of pits-----_-----------Lining material__ Q4_------ Diameter---!J'._`.��------Depth_..s��_�'----------------- N Cesspool: Distance from nearest well_________________Distance from foundation----.---------------Lining material_--____-..__-_._-__--_-____._____.___ ❑ Size: Diameter------- ------------------------------Depth----------------------------------------------------Liquid Capacity- --------------------------gals. I Privy: Distance from nearest well ---------------------------_____:_____-.----Distance from nearesf building.---------.--------------------._-.__-.._. 1 ❑ Distance to nearest lot line------ -----------/---- ---------- ---------- ------------------------- ---------------------- ---------------------------------------------- 0�2 Remodeling and or re air ng Idescribe�:-.-___.---- -------- - -- --- --------F--� � A Ob -------------------------------------------------------------•------------•--------------- ------------------------- ------------------------------------------------------------------------- -------------- i -----------------------------------------------------------------------------------------------•-----------------------------------------------------------------------------------------•-------------------------------- ----------------------------------------I-----------------------------------------------------------------------••------------------------------------------•-----------------------------•--------------------------------- + hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned ( g ) -------------------------------- (Owner and/or Contractor) ---------/-f- By:-------' s -- ------ 4'!11 Vii_. 5't--/r!_ (Title) �"`'�'`''".F/� (Plot plan, showing size of lot, to " tion of sys relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -- ----------- ------------------- DATE----------- � ----- ------------------ REVIEWEDBY----------------------------------- ---------------------------------------------------- DATE-----------------`--•------•---------•---- BUILDING PERMIT ISSUED------------------- -5 f -----.-^------- DATE------------------------------------ •--------------------- Alterations and/or recommendations: � ---- 6-------•-----• --------- ------------------------------------------- ------------------------ ------------------------ ----------------------------------- -------------------------------------- ------------------------------------------------•-------------------- ------------------------ --------------•----------------------------------------------------------- --I--------------------- ----- FINAL INSPECTION BY:_- --------- -- - - �_-.___ Date / -+ SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California _ Manteca,California Tracy,California F.P.0 O.