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FOR OF/FhICE USE: 3--------------------- ------- � -r . �� .. ...............2 1�.. APPLICATION FOR SANITATION PERMIT Permit No, ' -------- ----- ----------------- (Complete in Duplicate) --------------_- .This Permit Expires 1 Year From Date Issued Date Issued . .~�r_eo� 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 wifh County Ordinance No. 549. JOB ADDRESS AND L CATION -f- �� t. me----- ----- .---- Owner's Na -- ------ -- - -- -----------------------------.- ---- ------ Phone----•------------------• ----•-- Address ` ---------------- ------------------ ---- .. Phone------------ - --• -••----------- Contractor's Name------ .,mac � Installation will serve: Residence [ Aparfinent House E] Commercial E] Trailer Court E] Motel ElOther El g /X--s�.�--�------------ Number of living units: ..-. --- Number of bedrooms -_ -- Number of baths . .. Lot size ..... ._� Water Supply: Public system �ommunity system j] Private ❑ Depth to Water Table .. ft. = - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [I Adobe.Er"'�Hardpan C] Previous Application Made: [If yes,date--------------------] No New Consfruction; Yes R-No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic T k: Distance from nearest well.,.-------Distance from foundation__/4>.---.--.Maferial__ -----4 .,-- I`J�-._No. of compartments _-------F-� Size..1/� Cq__Li uid de th__ .i_ -.-.-___..Capacity Dis osal F Id: Distance from nearest wefi. -.---...Distance from foundation.._R:G'........Distance to nearest lot line---.-�-_-- p Number of lines.._.-_..r2...----- --. Length of each line-----�?4_.------------Width of trench--------- " ----------------- ' Type of filter material....!- - .tel-.De Depth of filter material...- �9 I' p �g------ -Total length---------- -- -D_--------------- --- See a e Pit. . —E p g Distance�to nearest well -_//)0_1 -.....Distanc m foundation�QQ-._._..Distance to nearest lot line-._�....._.... Number of pits.-.-�------------Lining material-e tc .--Size: Diameter---,33---F-------Depth-..... Cesspool: Distance from nearest well-----------------Distance from foundation..--..--------------Lining material--------------------------- Size: Diameter------------------------ -------Depth---------------------- -- .Liquid Capacity- q P Y gals. Privy: � n _Distance from nearest well----------------- __________________________Distance from nearest building-----------------------__-----------_---, ❑ Distance to nearest lot line----------------------------------------------,--------- -------__ ---- Remodeling and/or repairing (describe}:... 3-__ ---------------- m ---- ------------ ------------------------------------------------------------•--------•---------------------- •--------------------- ------------------- ------------ - --------------- ------ --- ------------------------------------ ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, We laws, and rules and Bgulations of the n Joaquin Local Health District. B ct Y:•--------------------------------------------------------- - - -- {Titl@� ne an or antra or r - ------------- - --- (Plot plan, showing size of lot, location of system in relation to wells, b ildings, etc., can be plated on reverse side]. �`' .. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------- DATE-. - /- - - ----------------------------- REVIEWED BY ------------------ ------------------- -- -------`---------------------- DATE---------------- BUILDING PERMIT ISSUED---- ------ - --- DATE_ t-=_, ==� ------------------------------------------------- Alterations and/or recommendations: --- - ¢ a� �� Zk ---------------------- ------ ------------------------------------------------------ ------------------------------ ---------------------------------- -------------------------------- ------------- --- ------------------------------------------------------------------- FINAL INSPECTION BY:....-.`__....-.-_a ----------- Date-- ------�----_-�� _ r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Houlton Ave. 300 West Oak Street 124 Sycamore Street 2D5 west 9th Street Stockton,California a Lodi, California -Manteca,California Tracy,California l F.P.0 O. 4 l - ke \