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FOR OFFICE USE: Permit No. .--....6 �•I _ _ APPLICATION FOR SANITATION PERM 1 I __.._. (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. Q03--fly--JJ ----------- I.--s---. ---------------------------------------------------- Phone --- -- V---------- JOB ADDRESS AN LOCATION_ -- -• - -- -------------� ---'�� - ' Owner's Name----- - - •---- ----------------------- -----------w Phone---•--------------------•-----•-- t s-_ _ . { Address �, - Contractor's Name---,t� '`-- ----- - - - - -------- -- -I� Phone ... f Installation will serve: Residence-E Apartment House ❑ Commercial ❑ Trailer iCourt ❑ Motel ❑ Other ❑ Number of living units: I._._ Number of bedrooms 3-__.- Number of baths )'----- 'Lot size ----------------------------- Water Supply: Public system 1771Community system ElPrivate OR Depth to Water Table k_ ft. 1 Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ] Clay lam Clay ❑ Adobe C] Hardpan ❑ , Previous Application Made: (If yes,date----_---...__.__--) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 'i TYPE OF INSTALLATION AND SPECIFICATIONS: . -T .(No-:septic-tank-or cesspool-permitted-if public-sewer is available within 200 feet.)— Septic Tank: Distance from nearest well_________________Distance from foundation____-ll____._____.Material...________._---__..____----_____._____.__.___- ❑ No. of compartments----- --------------- ----Size--------------------------------Liquid)depth- ----------- Capacity nce to re me- Disposal Field: Distance from nearest well---- --Distance from foundation-- f tre m Number of line - Len-9th o` ,e'"�c-� rte _------ Type of filter material 'epth o f materIa --- ---- Total e----- h_ -d--------------------------------- O-_{-- _Distance from foundation_ _ -- __.._-Distance to nearest ]of line_! '. ------ (10 Seepage Pit: Distance to nearest well---. Number of pits---I----------------Lining materia *---- -Size: Diaimeter--3------------------Depth ------------------------- `_ Cesspool- _ Distance from nearest well__ _____________Distance from foundation.-- --------- ---Lining material-------------------------------------- ❑ Si -----Depth------------------------------ -------I --------- Liquid Capacity gals. It Diameter------------------------- --- Privy: Distance from nearest well-------_-----------------------------------------Distance from nearest building------.-------------------------------___. ❑ - ----- --- ----------------------- ----- ------------------ Distance to nearest lot line- --- - ��--------- ----------------------- ----- --------- ------ ----------- -I: Remodeling and/or repairing (describe):------ ---------------------------------------------------------•-----------I'----------------•-- -------------------------------------------------------- I" - ----------- ----- ------------------------ 9 ------------------------------------------------------------------- ---------- ------------------------------------- pt ---_-----____ere_________certi__ __ _________have__.._rep -____________ _-____-_______--__and that the work will be done in accordance with San Joaquin___-__..-__-_-_____________-.__________- ---____.__._______.____..._..__--____._____._______. I hby fy that 1 pared this application Caun y F ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _ ----------------- ----•---------- -------(O_.wner and/or Contractor] cSt(Signed) ned - . y - - —_ .. ..� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY l ------ DATE_A_-?___6C-------------------------------------- APPLICATION ACCEPTED BY- ------ --- °'�---- REVIEWEDBY--------------------------------------------- ---------------------------------------•--------------------- �� DATE BUILDING PERMIT ISSUED-------------------------------------------------- - != DATE--------- ------------------- Alterations and/or recommendations:-- AX*------------- �'�.e---------�'---------- ----------------- ------------------------------------ - -- ------------- •-------- ------ -------------------------------------------------------------- ---------- --------------------------------- 11 --------------------------------------- ------------------------ - ------------------------------------ ------------------------ I) FINAL INSPECTION BY --. - .. II SAN JOAQUIN LOCAL HEALTH DISTRICT 5 1601 F.Haselfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Lodi,California a Manteca,California Tracy,California Stockton,California II F.P.C d. li