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1 .----------- ---------: t .ti x APPLICATION FOR- SANITATION PERMIT Permit No. `' .�._. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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 AND LOCATION___:�- _ __ a.GG� J J �------ ------ --------------------------------------------- Owner's Name $L�_lt � _ �1?- 1. ---- --- ---------- Phone Address . - -------------------------------------.------------•--------•------------•- Contractor's Name ------- 4 ...... ------------------------------- - ------ Phone------ -•------...._ ._ Installation will serve: .F,R'esidence t <Parfinent Ho se ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _ ----- Number of bedrooms Number of baths --e'**--- size _ l - Water Supply. Public system Community system ❑ Private ❑ Depth to Water Table6;;5Tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe ardpan ❑ E Previous Application Made: [If yes,date.__. } No New Construction: Yes ❑ No FHA/VA: Yes ❑ No�j�� TYPE OF INSTALLATION AND SPECIFICATIONS: 1. `'' `° ' r �h `4 p (No septic tank or cesspool permitted if public sewer is avail®ble within"200 fee .J S %%'`� Not of cam artmetst well `-�s=3 Distance from foundation____._._._________Material_______________________________________ y t ! p Liquid depth- -- ----------Capacity------ --------- ----- Disposal Field: '� � ' ° � � 1 p field: Disfahce�fi•om-nearest we.1i-_. a_.-� .D,istanee from found ation-______------------Distance to nearest lot line__.----------------- ------------------------- Distance ________= . Sj/ may Number of lines___. `'1. __Length of each line ___________ _ _____ ____Width of trench._ __.-___-. Type of filter material --------------- Depth of filterxmaterial ___._ __._ ___.Total length__ __ _ __ _________ - - -- ------------- Seepage Pi Distance to nearest well________ ?Distance m foundation-Z ---- Distance to nearest lot line__------_- i r d'e .,f Number of pits__._. _______Lining material_ Size: Diamefer__.. 3_---.-__-Depth_ ____. ..... Cesspool: Distance from nearest well ____Distance from found tion-------- . � .Lining material_____ .... __..___.__ - ------ El Privy: Distance from nearest well `ikDis Liquid Capacity gals. Size: Diamefer-_ ------------------ --------------De th----------------- = ,= write Tr m nearest building--------------------------------------- -- O F1 Distance to nearest lot line_______________ -r- � Remodeling and/or repairing (describ' � ------------- -- G -------------- -- ------------------ ------- ----------------------------------------------- ---------'-•----•---------------- -- -------------------------------------- -----------------"-`- `� == ;___ - = . . - .-- - - _..=_r,-------- ---------------------•------- - ------- -------------------------- ----------------------------- ------------------=� ' ---------------- ---------------------- -------------------------- ------------- -- I hereby certify that ! have re aged this application and that the work will be done in accordance with San Joaquin County. Y Y P p. PP ordinances, Stafe and rules re' ulations, of the San Joaquin Local Health District. (Signed)----- »t Q _- ______________________ caner and/or Contractor) �--------------- F BY:---------------- --------- - Irtlel j (Plof',plan, showing size of, location o; system to relation to wells, buildings, etc., can be placed on reverse side). ' 1, { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- t. REVIEWED BYI s7- DATE ,.3--Z �h -------------------------- ----------------- I--- DATE - ---- ------ ------ -------------- ----------------- = -------------- _ BUILDING PERMIT ISSUED----------------------------------------- -------------- ------------------!-- DATE Aferatons and/or r ommendations______________ - - 01 ----------------- - I -a�-f/-------------- --- - --- ---- -- -- , - - �------- __ p i ------------------ ---------- ------------------------------------- -------------------------- ------------------------------ -------------------- - ------------ ------ ------------ ----------------------------------------- - -- t FINAL INSPECTION BY:. = Date-- '- ------ ------ f_�_�__-� . - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 105 West 9th'Street Stockton,California Lodi,California Manteca,California Tracy,California F,RCO.