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FOR OFFICE USE: .J'"_ - 6 ----- ------------/f4 7fJ ' ------- ------ ------------ ---------- !/ APPLICATION FOR SANITATION PERMIT Permit No. 1 --------------- --- ---------- --�r"o--- (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 CATI N__� _,,�! -.-Q - - --• ----------------------- ------------------------------------------------------------------------------- Owner's ------- Name---- ------------------------ Phone -----------------•--•-- Address Contractor's Name Phone----------------•----------•-----•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1___ Number of bedrooms -;Z._ Number of Baths --- Lot 60size49 --X-`/Q----------------------------- Water Supply: Public system gro'Community system F1Private E] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R_0� ardpan ❑ Previous Application Made: (If yes,date. I No J2,-* New Construction: Yes ❑ No g4—,—FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: ✓ Distance from nearest well________________Distance from foundation--------------------Material.._..-----------__.______._.____ ____. X11 I$ / No. of compartments----- -------- ----------Size--------------------------------Liquid dept Capacity Disposal Field: Distance from nearest well--- '__-_.-Distance from foundation. ___ _.--_.Distance to nearest lot line____._.__ en th of each line-p6- � Width of trenc - ------------------------- L`�'�� Number of lines._-------� .-�._ g --------� � /T/ G� (L�� Type of filter material/e, - G_ epth of filter material---/f_ ______Total length_- s ___________________.___. Seepage Pit: ' Distance to nearest well-____- -______Distance from_fo�oj dation____________________Dist nce to nearestlot_Ln -}} __ _ Number of pits... --,/-----------_.__Lining material . Size: Diameter._ - .-- -_ ___Depth_Z.- ____**` A4 _ _ Cesspool: Distance from nearest well-----------------Distance from foundation------------------. Lining maleriafi------------------------------- F-1 Size: Diameter- -- --------------- --- ------------Depth----------------------------------- -- ------------Liquid Capaci4----------------------_---gals. Privy: Distance from nearest well--------------------------_----------------------Distance from nearest building.___. ------ --------------------------- ❑ Distance to nearest lot line.. --- --- -- --- --- ----- --------------------------------------------------------------------------•------------------- Remodeling and/or repairing (describe):_.______ _______ _____ �� ------••------a------------------------- ---------- --------------------------------------------------`------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ----------------------------------------------------•---------------------------------------------------------------------------------- ----------------------------------- ----------- I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andrules andregulationsof the San Joaquin Local Health Disfrict. (Signed)---------- ur s -7` �---- {yO�w� 7�or Contractor) By:---------------------------------------- -- --------------- - ---- --- �� - - - --------------)Title)-- ,��/�.c`r ---- (Plot --(Plot plan, showing size of lot, location of sy in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- -------------------------------------------------------------- DATE- -- = 6 � REVIEWEDBY------ ---------------------------------------------- ----------------------------------- --------------------------------- DATE---- ------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alter�ions nd/or recq.m pndations:.-- ------ ----- --- --------------------------------------•-------------------------------------------------------- JX16- --------------------------------------------------------` -` _---- --- -__--------- 0..? - ---- FINAL INSPECTION B t�. Date_...----- _.�.��................ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC7-