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FOR OFFICE USE: -- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------- -- -- ------------- (Complete in Duplicate) - ------------- -- - �t Date issued - ---.------------ ........ This Permit Expires it Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct rand install the work herein described.A - This application is made in compliance with County Ordinance No, 549. 20 NICK 9P -� ¢ JOB ADDRESS ANALATION----•- - --- ---------- c'''` �' D"d -1�- EOwner's Name-------- --------- ------• -------------------------=------------- --- ----------------. PhoneAddress----------•-------- - flow_ 3 7 ------------ ----------------- - -----n-------------------------------------------------- r f 1 Contractor's Name- T -' °- --•-------- Phone.._-.... -- ------ &/ ( Installation will serve: Residence F] Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other ✓I' Number of living units: _ __ Number of bedrooms " __ Number f baths "__ Lot size ----C. ---- --_. _________________ __ Water Supply: Public system ❑ Community system ❑ Private Number Water Table ----- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam:❑ 'Clay [I Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Y - (No-septic-+ankrorrcesspool-permitted,if-public-sewer,is-available within_208 feet.)_ v. - Distanc from founaation_-____,�lt ._�___.Materi L----_ .�G n !�!�------------- T Septic T nk: Distance from nearest well---- _.-- �e'p, - -' ':Size x� X Liquid depth------- - - - ----- Capacity No. of compartments_.__- qu S � -__Ca acit tc':I�_. � ` Dispos Field: Distance from nearest well -Distance from foundation------- _0.___._Distance to nearest Iodine----------------- --- _______________ El Number of lines----------------------- Length of each line-------`Q-�-------------Width of +Tench.---- ------------------ --•-- Type of filter material--------- � -_-_Depth of filter material--_---14---------.-Total 4ength------ ----------------------_------ Seepage Pit: Distance to nearest well_____________________Distance from foundation-------------------Distance to nearest lot line.___-------___._. ' 07° Number of pits---------------------rLining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cess ool: Distance from nearest well-------------------- from foundation__--- _----_._-_--_.Lining material-.-.--.-.--_------_.-_-_________-.. p , ❑ Size: Diameter--------- ------- '-- ----- - ---- -De th----------------- uid Capacity---------------------------gals. lPrivy: Distance from nearest well ----------------------_._.___--------------_---Distance from nearest building----------------------------------------- t ❑ Distance to nearest lot line----------------- ------------------- - ------------------------------------ ------------------------------------- -• - ---------------- Remodeling and/or repairing (describe):J------------------------------ ---------------------------------------------------------------_41-------------------------•----------•---------. t } ---------------A-----------------------------------------------------•-•--------•----•--------------------------------------------------------------------------- r I ------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with Sart Joaquin County ordinances, Stat ws, and rules and regulations San Jo quip Local He h District. __ __________ To --------------------------- (Signed) -----------'" ------------------------------------------�er and/ar Contractor) r ----)----------- _ __* =--- -- -(Plot plan, showing size of lot, locatin of syst m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.! DATE_,___ " "._-G ----- REVIEWEDBY---------------------------------------------------- ----------- --------------------------------------- ------------------ DATE------------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------- -------------------------------------------- DATE--------------------------------------------------- Alterations -------=----------------------------------- Alterations and/or recommendations---------------------------------------- ------•----------•-----------•--•--------------------•-•---------------------------------------------••------------- _------------------------ ---------------------------- ------------------ - p�V --- --------------------- ------------------------- --------------------------------------------------- -------------------------• ------Cf --------------------- -------------- ............. --------------------------- - -----------------------L--------------------------------------------------------------------------- ---- --------------------------------- ------------- -------•---------- --••-------------------•----------•--------------- ---•--- ------------- - � -------------------------------- Date....FINAL INSPECTION BY:. --------- ------------- . O .---- SAN`JOAQUIN LOCAL HEALTH DISTRICT t]C� 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.p.G`a.