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FOR OFFICE USE: i - ` --- ---- - 7 l� APPLICATION FOR SANITATION PERMIT Permit No. ..... �-___._ � (Cornplait-in Duplicafe) � --- ------------- - - -------- ' -- - - -- - Date Issued ___________ This Permit Expires_1 Year From Date Issued Application is hereby'made t e.I Son Joaquin Local Health District for a permit to construct and install the work herein de ibed. c� This apls r�f� g i 11"n ith County Ordinance No. 549. JOB ADDRESS A ILOCATI o '--- - ---- ----- -_ --- to IrOwners Name .. .------------------------ ---- -- ------------ --------------------- Phone--- . ss.......................,'I: -- � :''�`� ' ------•----------•------------•-••--------•--- A re ---- ---- - - ------------------- Contractor's Name--- I�I ------•-------------------- Phone..-------••-•----------•----------- 11 ' Installation will serve:;�i Residence rr ❑ Apartment House ❑ Commercial ❑ Trailer Court P/vl!lotel ❑ Other„❑ 4 , Number of living units:--L:__ Number of-bedrooms ___ _ Number of the __4_ Lot size Community system ❑ Private ft. Water Supply: Publics stem ❑ M �f W Character of soil to a!Idepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yas,date____________________f No New Construction: Yes ❑ No A/VA: Yes ❑ No TYPE"OF I.NSTALLAT4ION AND SPECIFICATIONS: (No septic tank�'or cesspool'permitfed if public sewer is available within 200 feet.) Septic Tan Distance=-from_nearost-weHl ,_-__'Distance from foundation__Z----------.Mjateriai-------- ____-._*---- No. .N . of compa tments.... .�_ ,� ___,. -/-,&'c{uid depth:'_!>`__ ___.____Capacity-1�-'r _� � ., Size Disposal F- Distance from nearest well'4.0-----Distance from foundation_._,/,�p--,- Distance to nearest lot Number-of.'lines--- Length of each ------Width of trenth__c;�_* -------------------- Tyipiile os filter material____/Y?�:___..___Depth of filter material_.. ___'�__Total Ings_..e�O ___`_---------------=--- Seepage Pit: .. 0 Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ -Niurnber of pits----------------------Lining material-----------------------Size: Diameter------------------__Depth_------------------------------ Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material--_..__._-:.----___.--____-____-.._. ❑ Sipe: Diameter: ---- -------- -- ---- ------ Depth--------- -------- ------------ -- ----------------Liquid Capacity---------------------------gals. Privy: Distance fromnearest well------------ ------------- ----------------- --Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot lire---------------------------------------------------------------------- _----___.__._-__-_.---- Remodeling and/or repalr;ng (describe):---- ' ��`J --------------- l� :�s = S ------------------------- ---- __--___--_-_-_----___.__ -------------- ------- _-_--__---.______._._ __..____..________----..___-_-_----_. _______-----_--__-_---_-__-----------.---.--.-_.___ ________________ ______ _ __ ----------------------- ______-_ -------- _____-_-___•__•-•-•_---•--•_-__-...--.-....-_--__--_-•------.-...--_-___--_----.---_-.------.-_---_-_---------------------------.--------- -----------------------------------------------------------�i------------------------------------------------ I hereby certify tlhat ve prepared t ' plication and that the work will be done in accordance with San Joaquin County ordinances, State laws`, d les alnd reg 10 of the San Joaquin Local Health District. t Owner and/or Contractor (Signed) - --- Y�Z� ------------- ---------------------- --------------------------- { / ) �N. JJ . // Y i:------ - -- - - Title . L/`'__- (Plot plan, showing sizle ot; location of system in relation to wells, buildings, etc., can be placed on reverse side). I' J� FOR DEPARTMENT USE ONLY ;i APPLICATION ACC EPTED BY �------`-- ------------------------------------------------ ----------- DATE------J� �� --------- REVIEWEDBY----------- - --------------------M---------- -------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------- ------------------- DATE--------------.-----_ Alterations and/or recommendations----------------------------- ---------------------------------------------------------------------------------------------------------------------------------- li, 1p ------------------------------------------------------------------------------ 1 i -- ---- - ---- -- - ----- — ---------- - _....� - --- --------------------------------- 01 FINAL ---------------- FINAL INSPECTION BY.....-.- I. Y --------- ---- ----------------- Date-- l'-- \- -----.- ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellai Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California I Id -' _ I