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i cE�sE: APPLICATION FOR SANITATION PERMIT~ Permit No. .__1.. _ _G 1' (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued Date Issued Ft 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 AND L CATION_-- --- ---------- a = _ ..._.. OwnersName----------- --------•----------- ---•------------------- ----------------------- ----- one-- ---•------------------------------- _- Address----------- ---- -- - ------- --- - --C�'---�- = -------------------------------•-•---------------- --------------•------ -- ...._.. Contractor's Name v -----------•------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ J Number of living units: _/-_ Number of bedrooms,_ Number of baths -- Lot size r , --------------------- ---------- s Water Supply: Public:system E-] Communitysystem Private E] Depth to.Water Tablet. Character of soil to a depthrof 3 feet:.. Sand [-] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �rdpan ❑ I Previous Application Made: :]If yes,date--------------------1 No Me-lNew Construction: Yes Z?"go ❑ FHA/VA: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well____"""._-Distancejrom foundation___s��_____..Majerial.__------A---- ----- _----. No. of compartments _. Size'-f/- _ _ iquid depth._____!___...- Capacity/..-Ped---- Disposal Feld: Distance..from nearest weI!___ Distance from foundatiorl i`*_a_-._--Distance to nearest lot line__4/---- " Number of lines------_?_... ength of each line_ .Width of _ trench ,t. _..-------------------- _1 _--_-__________--/� - Ae th of filter material__ `�___"Total- length .-•---------------•--TYpe of.flter material (� 4 Seepage it: Distance.to nearest well----------_____Distance fr foudation_��_.___._. Distance to nearest lot line___^_ Number of pits----�----- g �- --Linin material-_. -- -� -size: Diameter---- ----------------Depth__"�'-`---------------"-._ D Cesspool: Distance-1from nearest well--------------___Distance from foundation--------------------Lining material__._.___--___-___---:___._-_ ❑ Size. Diameter--------------------- ---------------Depth-------- - ------------------------------------------Liquid Capacity------ gals. fl► Privy: Distance from nearest well___...._______." _ Distance.from nearest buildin " 3 - , ------------------ = g{---------------------------------------- 00 +� ❑ Distance to nearest lot line____ ------------ Q� k =----------- ---------------------------•--------- ----------------------- 1 Remodeling and/or repairing (describe) 10� ---------- -------•------------------•------------- t d ---------------------------;--------------- ------------ ------••------•---•--- ---------=-------------------•---------- -------- -------------------------------------------------------------------------_----:------------•----------------------:-:-------------I-----•---------- ----------- ---------- ` I hereby certify that 1 have prepared this.application and that the work will be done in accordance with San Joaquin County , ordinances, State laws, and r es,and,regulations of the Sari Joaquin Local Health District. (Signed) --- --- -421-- --------------- ------- --- -----------------------------------------------Owner and/or Contractor) By---------------------- ------ --------------- ---------------------- --------------------------- (Plot ------ -- •(Plot plan, showing s6 of lot, location of system' ation to wells, buildings, etc., can be placed on reverse side). -;�I FOI DEPARTMENT--USE ONLY I APPLICATION ACCEPTED BY__- y L - -- -- - - --- DATE------. 3 BUILDING PERMIT ISSUED ;, -----------------, DATE ----------------------- REVIEWED BY- ----- ----- ----" ---------- - ------------------ DATE" Alterations and/or recommendations: + ---�� -- ---------------;----------------- _Ia_, -?------ --------- -------'•---------------{. ---�-------L.____� rix� --'r----=-------- - ---- ----s.c----�-------------------' -� •--------- ` -------------- --- -. - c --------------------------------------------------------------------------------------- FINAL INSPECTION BY:..----- ------ Date-------- �` - SAN JOAQUIN LOCAL HEALTH DISTRICT IL 1601 E.Hazelton Ave. 300 West Oak Street '124 Sycamore Street 205 West 9th Street Stockton,California ; Lodi,Colifo►n]a s e y � Manteca,California� .* _ ,1 Tracy,California ES 9 REVISED B-99 3M 3-'63 F,P.CO.