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r 'FOR OFFICE USE: 16.x- p, o APPLICATION FOR SANITATION PERMIT Permit No. .a1 _..Q. -------------------------A. (Complete in Duplicate) 2 -A, t I This Permit Expires I Year From Date Issued bate issued Application is hereby made to the San Joaquin Local Health District for a permit to onstruct and ' stall the work herein described. This application is made in compliance with County Ordinance No. 549. baa Z ! - - ----------- JOB ADDRESS AND LOCA N - -----•---------- +, Owner's Name__- + -------- --------------------- ---------------- - Phon.".(_-&_G_a a3 Address•--------------------- `j' �i- tr- -� ^------- -- ------ -------------------------`- Contractor's Na _ _._. __. _ - --- __ �*� --- -- -------%_.. . Phone-" Installation will serve: Residenc Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I--- Number of bedrooms .SCS.- Number of baths __/__._ Lot size --`---------------------------------___-_-_-.-------.---_ Water Supply: Public system E] Community system [-] Private F1 Depth to Water Table.60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe -lHairdpan ❑ Previous. Application Made: (If yesdate....... ...........] No,❑ New Construction: Yes ❑ No HA/VA: Yes ❑ No ❑ F TYPE OF INSTALLATION AND SPECIFICATIONS:. t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) $ icrT Distance from nearest well-----------------Distance from foundation--------------------Material------.-_-__.-.---_. No. of compartments-- --_ - {{Size---------------------------------Liquid depth---------- ---Capacity------------®----------- o Distance from nearest well_144T�✓_Distance from foundation----- f_-Distance to nearest lot line----�3__00P------ ------------- _---- Number of lines---�------ --- ------- -----Length of each line__c _ ��;_.Width of trench___._. __.---�_.____ $ �� 4 Type_of filter materia Depth of filter material----_---/ Total length-_-_--_--_______ _,Q_.-�.___._ I D+stance from foundation- - Distance to nearest I line________________ i a P' Distance to nearest well_l _ _ _. _..._ _ _._..__. l Number of pits.._.________________Lining material__ ,0 . --.----Size:tDiameter_c4t ��_-.Depth--- tS-_%.-__-_.--_----_ oa Ln k Cesspool: Distance from nearest well-----------------Distance fro foundation --.-.. --__t---..Lining material-------------------------------------. i ❑ Size: Diameter----------------------- --------------Depth------------:------!------------_ ='........Liquid Capacity------------------------ -gals. y h Privy: Distance from nearest well-------_----------------°------__.;__'.-------_-_Distance from nearest building ._-_---_---------..._-.._. ❑ Distance to nearest lot line----------------- ------------------------------------= '' = . Uxj Remodeling and/or repairing (describe)---------------------- -------• • - ------ _ �: --� -------------------------------------------------------•-------------- ---- - - -- ------- = -- - - - •-- - - ---r --- -- - --- -- ----- --- �- ! hereby certify that I have prepared this application and that the work will be one in ac rdancerwith San Joaquin County ordinances, State laws, and ules and regula ions of he San`Joaquin Local He th District. 't ,I (Signed)- Q'-. . ie ,Cor Contractor) By----------------------------------------------' „--------------------------------- - - ---- ------ ----- -------- -----(Title)------ ---------- ... --- (Plot plan, showing size of lot, location of system in relafi to wells, buildin , etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY—i- 4 NLY'"'•""• APPLICATION ACCEPTED BY-_.-_ ' ----------"-�.._----- ------------ -----------------------•---- ------------------ DATE----------�-=�_-moi---- - ------------------- REVIEWED -REVIEWED BY------------------------- ------- --------------------------------------------- -------- --------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------- ------------------------------------'-----•-------------------- - ---------------- DATE------------------------------------------------------------- I Alterations and/or re co end tions: -- ---- R ------------- -- ------------------------------------------------------------------- F �s=� ......�` - �`' ------------==-=-=---=---------------------------------------------------------- ---------- ---------------------------------------------------------- ------ - ------------------ ------------------------- - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- e f __.--__--_--_-----------------------------------:----------------------;.-.--- -- -----:-- - ----------------------------------------------- ... .�- ------------- ------------------------------ FINAL ------ .____...----.._._.... FINAL INSPECTION BY:------6 ---------- Date------- ---- --- --'- ----------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California 'Tracy,California F.P.C C.