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FO FFICE USE:�-�-------- --- --- Y ------------------ -------- APPLICATION FOR SANITATION PERMIT Permit No. ...............�.... ------------------------------ ----- -------- (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 a permit to construct and install the work herein described. This application is made in compliance with County Ori ante No. 549. JOB ADDRESS AND AT NI- Q_C. . ..�------- -------- Owner's Name------ ----------- ---- -------- hon — __ ~-,-�------- Address ti - -------------------- - �J ---------- - Contractor's Namr� _ ____ _ Y_ ,[! t!zrfL.--- Phone..�� _._ Installation will serve: Residence artmen House ❑ C/ornmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- -- Number of bedrooms -_Y. Number of baths _/__ Lot size �� ------------------------------ Water Supply: Public system ❑ Community system ❑ Private e t.h to Water Table-74-"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 ZP, <A/VA: Yes ❑ No ❑ TYP OF 1NSTALLATI NAND SPECIFICATIONS: (Nose ank or cesspool permitted if public sewer is available within 200 feet.) i a Distance from nearest well-----------------Distance from foundation--------.----------.Material No. of compartments--- - -------- ---------jize--------------------------------Liquid depth ---------Capacity..-------------•--•---- Diele. oral Distance from nearest well,. .. _Distance from fcundationy ___.__.Distance to nearest lot line--_- -. Number of lines___._ Length of each line r Width of trend � Type of filter materi r�_I� _ p �. -_ _De Depth of filter material.._.__-��!--Total length------------------------- {j e • '' Distance to nearest well_/�.�_ _-_-Qistance undation___�Q��_ Distance to nearest lot line____ Number of 1ts_.. .-_-.-_. ___Linin material_ __ p g - --- Size: Diameter. 'T _.Depth- r__------------- Cesspool: Distance from nearest well-----------------Distance from oundation____.._---_---- -.Lining material--.-----.-..----___.._.----.____-__ [❑ Size: Diameter---- -------------- ---------------Depth--------------------------------------- ------------Liquid Capacity--- -----------------------gals. Privy: Distance from nearest well------------------------------------------ - Distance from nearest building..._-- ---------------------- p ❑ Distance to nearest lot line_ - - ---- ------------------------ ----- ------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe)=----------- ------- ---------------- -------- -- --- ----------------------- ---•------------ ----------------------------------------- ------ --------------- ------- ----- 1 hereby certify 4af I have prepared this application and that the work will a done in accordance with San Joaquin County ordinances, St 7UIeS and reg tions oft San Joa uirt Local He h District. Si ned( 9 ) !'-==I Wil' --- By: r ntractorl By:.-. .'. -_(Title)------------ -------------------------_---- - -- - -------- (Plot plan, showing size of lot, location of system I lation we s, buildings, et ., ca be placed on reverse side): FOR DEPARTMENT USE ONLY l L APPLICATION ACCEPTED BY----- -------------------------------------------- ------------------- DATE----- REVIEWEDBY---------------------------------------------- -- ------------------------------------------------------- ----------------- DATE- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE Alteratio and or recom e_ndatio s:--.__----_________________ ___ - ------�r� Z-v---...Z -- - - ----------------------------------------- --- ------- --- ---------------------------- ------------- ----------------- -- -- ---- ------------------- - --------- ------------------------------ --- ---- ------------ ---•----------------- ------------ �-------1-------------------------- ........ -------- ----------------- FINAL INSPECTION BY:__-. . ._ _`�... (------------ ---Date. �Q -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California