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14 RR OFFICE USE: �---------------------f-('----__. APPLICATION FOR SANITATION PERMIT Permit No. ------------ --------------- ----------- -- (Complete in Duplicate) Date Issued ......................................................... This Permit Expires 1 Year From Date Issued 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 AN LO ATION sz -- -- ---- ---- / *- Owner's Na -------------- - Phone _4.11. 2 Address-------------- -- .-- -- -------------------- --------------- --------- --- - ---4- -or-------------- -- -- --�-- lss � --..---- p -W---- -�Confiractor's Na Installation will serve: Residence ®__Xpartment Hou Commercial ❑ Traile Court ❑ Motel ❑ Other ❑ Number of living units: j---- Number of bedrooms -y- Number of baths of size _..- ....'-------..,,��_.__._ Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table7..�--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 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: o septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well.................Distance from foundation--------------------Material .-......-........_----------------------------- No. -- ---. No. of compartments--------- Size--------------------------------Liquid depth----------- --------------Capacity----------------------- Ta a� ....D' sal tante from nest well_ � . Distance to nearest lot line..- .�4 Number of lines._ Length of each linec��Q-- - --- -- Width of trenchC]2fC--/ - - --- Type of filter ma - Depth of filter material___ tal length------- ------------.� \� `1) Seepa e Pit: Distance to nearest well_____ _______ ________Distant from foundation----- .-- Distance to nearest lot line----- ._ d Of Number of pits.---- ----- Lining material;l�bF-- --------Size: Diameter____5_ Z_ --- --Depth..-,Z�--------------_ Cesspool: Distance from nearest well-----------------Distance fro foundation--------------------Lining material....... -------------------------- 0 Size: Diameter--------------------- ----------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------..-------------------._-Distance from nearest building------------------------------------------ n Distance to nearest lot line--------------------------------------- - -- -------------------•-------------------- ------------------------------------------------------- Remodeling and/or repairing (descriiJe):------------------------------------- - --------------------- ----------------- --------------•----------- - - -----•---------------------------•---- ---------------------------------------------------------------------------------------------I --- - ------- --------------- ------------- -- -- ---- ------- -------------.- ---- ---------•----------------------------------------- ---• ----- - - -------- -- ---- --- ------------------------•-------------------------------------------------------------------------•-------- ---- -------------------------------------- ------------------------------------------------------------ I hereby certify that 1 have prepared this application and that-the-work will be done in dance with San Joaquin County ordinances, State laws,_W rules and regulations of the Joaquin Local Health District. �5a & �E ,. .--- ----- --------- -- - -------------------------"�:�� or Contractor) (Signed) S)✓PTfC 'FAN1•C SERVICE By32915.E.-Miner.Ave.,- H4D.fr-3541------------------------- -_ ------ ------------------ITitle)---------------------------------------- --- - ..------------ (Plot plan, showing size of lot, location of system in a+ion ells, build' s, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - = ----------------------------------------------------------------- DATE-- �1' �� S' ---------------------------- REVIEWED BY--------------------------------- ---�-- ---- ----- --------- ------------- ---- DATE--.-- .-------- ------------- ----------------------------- - --- -- --------- ------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- -------- ------] DATE-------------------------- ---------------------------------- Alterations and/or recommendations:-------f:! -:.GQ.z".----}P.4.e-d° -Q =-------------- ------------------•--------••---------------------------- --------------- -------------------------------------------------------- ----------- --------------------------------------------------.----•- -------------------------------------------------------------- ---------- -------------------------------------------------------------------------------------------------------- -------------- --------------------- --------------------------------------------- ---------------------------- ------------------------------ ---------- ----------------------------------------------------------- ------------------------------------------------------------------- ------ --------------------------------------------- ----------- ---------------- -------- --- - --------------------- - ---------- --•-------------------------------------------------------------- -------------------------------------------- 4e---- FINAL INSPECTION BY:---- `P-e---y -------------------- - Date---- -•- -------- --------- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.14ozoltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r-F-CG.