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FOR OFFICE USE: 1 0 �' -- -/43% + _.__- -- --� Permit No. ._d___ l -- -------------- - ; �pr APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ------- ---------- I -----.----.- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with Co' ty Ordinance No. 549. ' ------------- JOB ADDRESS AND LOCATION_--�--- � -------••----- Owner s Name----- -..fiL.. --- ---------•---- ----------------------------------------------- - -------------- ----------- P ---------------------------- ------------ Phone------------------------------------ Address-------- t ----------------------------------------- Contractor's Name---- � ----1-�------------ --- -- Phone---------------------••----------.. - - - -------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _--.1_-iNumber of bedrooms ,2,_-_ Number of baths 4---- Lot size -fes?-----------•-------•------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table'_"� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ aardpan ❑ Previous Application Made: {If yes idate--------------- ----) 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 within 200 feet.) Septi ankr Distance from nearest well-----------------Distance from foundation-------------------Material.-----------------.----------------- - ---------- No. of compartments--------------------------Size---------------•----------------Liquid depth Capacity Disposal Fie! Distance from nearest well-_- -rDistance from foundation---/o"_l.......-Distance to nearest lot line--_,c---- Number of lines------ ------ --Length of each line---3A- Width of trench..--r %t_:s"---- ------------ Type of filter material""" P _._"_"""-Depth of filter material__ "" ------.-Total len th"-":3_CL------------------------------ f 9 a Pit Distance�to nearest well-------- ------Distance from toundationl�"---r � ---------.Distance to nearest lot line__ ��"--__ SeepJ material"_ faG ----.Size: Diameter----- 3- .-----Depth----a2g�".. ------ [ � Number of pits'---I-------- Lining f Cesspool: Distance from nearest well---------------- Distance from foundation....---.-------_-..Lining material--------------- --------------gals. ❑ Size: Diameter----------------------------------- Depth-..-----------:---------.-_- ---- Liquid Capacity g Privy: Distance from nearest well---------------_"-.--.-"--1-- - --------------Distance from nearest building--------------""---------"""-------- ----- G ❑ Distance to nearest lot line---- "-.----""-.. -- 11 --------- --------------------------------------------- I Remodeling and/or repairing (describe)-------------- -------- Y ----'---------------------------------------•--------------------------------- ---------------- --------------------------------------------------------------•---------------•------------------------ ------------------------------- t --------------------------- -- ------------ --------------------------------------'-------------------------------------------------------- ------ ------ --------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. • --------------- < --------------------------------------(Owner and/or Contractor ( )Signed --------4o-- ----:__� ----- ---------------------- ------ - --- -- ----------------------------------------------------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------0-` =------ ------ ------------------------------------------------------------ DATE-------1-=-3�� ------------------------------ - ( REVIEWED BY------------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------- ----- --- ------- DATE----------------------------------------------------------- tetons and/or recommendations:------- -------------- ------------------------------------------------------------------•------- ---------------------------------------------------------- -------------------------------- --------------- -------•------ ------------- --------------------------•--------------------------•----------------------------- 1 w - -- •------------------------------- ----------------------------------------------------- - J 6 -------------- -------------------- ----------------------------- -------------- ------------------------------- -- I /� �f --.�_- . FINAL INSPECTION BY:----- .r'i=------------------ ----------- Date- - = •' SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Haselton Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California ' Lodi,California Manteca,California Tracy,California F.P.CO.