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rvR vrril.e uot: �. __.__.._�_ - APPLICATION FOR SANITATION PERMIT Permit No. --------- -------------- ------------ ---- ----'--- (Complete in Duplicate). a� / -- ---'�--- This Permit Expires 1 Year From Date Issued � Date Issued ._/ ---- 6 6 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 LOC ATI ON--/-07 _ t -Z�3- 6l0-4J Owner's Name - -"-- �,/ � ------- '14 _�.. �--.- -• - -------� �"""--_�_ �?' ------- -------'-' - --- Phone---'---------------••--------- ` ' -- ----- ---- - •` - ------- "v------------•----- -- Address-------------•-- `•_Q F Contractors Name----_-___ --------- Phone Installation will serve. Residence ❑ Apartment House ❑ Commercial ❑ Trailer Cetrrt ❑ Motel ❑ Other ❑ Number of Irving units: ------- Number of bedrooms -------- Number of baths -------- Lot size Water Supply: Public sy sternCommunity system ❑ Private Depth`ta Water Table ________ ft- f,3 feet: Sand ❑Character of sod to a depth o Gravel D? Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑' Previous Application Made: if yes,date___________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: � (No septic tank or cesspool permitted if public sewer is available wi+hn 200 feet. ! Material Septic Tank: Distance from nearest wel!_________________Distance from foun��tion__.---------------- _-_-_________.-______.___.._ ,i Liquid p a W ❑ No. of compartments------------ -"---- Size ' - uid de th--- Capacity Disposal Field: Distance from nearest well-___._____----.-Distance from foundation-------------------_Distance to nearest lot line.__________.__- - ;e I ❑ Number of lines-----------------------------------Length of eaW.IAO ----------------- �- ------.Width of trench-'- ----'- ------------ - a Type of filter material-------------------------Depth of filt r,material-- Total length------------------------------------------ Seepage ------------------------- P� ------ p g o nearest`well___________________-Distance fro m�foundation__________________.Distance to nearest lot I'sne._____..________ -� ee a e Pit: Distance t, its.____._-__- ❑ Number of p I ----------Lining material------ -------- ------Size: Diameter------------------ ----Depth-------- ---------- Cesspool: Distance from nearest ell__ID'D'-----'!Distance from foundation_:f `----�-- ining material__. -.` -_ Size: �r_I -#� j' �h De th-' ° ' _---------------------------------Liquid Capacity ----------- -------gals. C Privy: Distance from nearestrwelf_-.-,-�_ ____-. � __Distance from nearest.building--------------------------------------- ' Distance to nearest lot line_________ 1 II I Remodeling and/or repairing (describe):_______________ .- h ---------- --•--------------------------- ---------------------------- ---------------------------------- ------ --------- M-----------------------•-----•--------------------------- -------------------------------------- --------------------------' - ' w I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County : C ordinance$, St a laws, and r. es and regulaf ns of the San Joaquin Local Health District, (Signed--- ---- -- -- ----' . -- ------------ ---------' -----.--(Owner and/or Contractor) By:------------ 1I -- Tale (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f�`� ---------------- ---------------------------------------- DATE--- , REVII WED BY------ ---- - =.�^�_^�- _- ----------'-- APPLICATION ACCEPTED BYi------ -'--- --'� ----- ------- - -------------- ------------------- - ------'---- DATE--'---- -- ---'--------'------'------ -------------- ---'- BUILDING PERMIT ISSUED----- DATE } Alterations and/or-recommendations---------_-----------_ --------- ----------------------------------- -----=--------------------- ---------- ----------------------------` ----- ----- -"- -- -------------------------------------------------------- II . - FINAL INSPECTION BY -__ _ -_ - - �- -�� Date = ------------------------------ ----------- SAN ------- -SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street I 205 West 9th Street Stockton,California �I Lodi,California Manteca,California Tracy,California I sF F.P.CO. Y