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FOR OFFICE USE: T --------- 3 { APPLICATION FOR. SANITATION PERMIT Permit No. ------------- ------------ (Complete in Duplicate) �.. „ �, _ pate Issued _------- ------------ This•Permit Expires 1 Year From Date Issued —Aprlicatioti'is-hereby'i-nade-to the SanJoaquin'Local Health rict for a permit to construct and install the work herein described. This application is made in compliance witli County Ordina e o. 549. JOBADDRESS W LOCATION/ ----- ----- -.-L---------- ---- ----- ------------ ----- ----------- --- ----------------------------------------/--�-- --�j----- Owner's Name::---* {:�=-l�r�[.A'" __Y^Rj _P_K---- �-•----- - ---------- Phone-----77U. 7 1 ------...Address CT i Phone �. 4- U ---- Contractor's Na61 me------- Installation willserve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living„units: -------- Number of bedrooms _ _ Number of baths J----- Lot size ------------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑' Gravel El Sandy Loam ElClay Loam ❑ Clay El Adobe Hardpan C1 Previous Application Made: (If yes,date._-_-----N.--------) No � New Construction: Yes ❑ No� FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I(No septic tank or.cesspool permitted ifpublicsewer is available wi+ to tfeet.) Septic:Tank:JW Distance from nearest well-- -- ----------Distance from fo ndation----------- -- _Material --------------------- -----------------• Liquid depth❑g?C56 No. of compartments------------- ------------Size----------------------- ----------- - ; - ------------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation___._____.__.______.Distance to nearest lot line."_-------.-----. lin e-----------------------------Width of trench.----------------------------------❑E,VLSfW iINumber of lines-----------------------------------Length of each G tType of filter material-------------------------Depth of filter material----.------------.-----Total length-----------------_------------------------ Seepage Pit: Distance,to. nearest w-ell_,�&V E_-_Distance from foundation---3�-------Distance to nearest lot hne----------------- Number of pits- I)--Lining material _. Q.C.Kt--. Size: Diameter._ _ ___..-----Depth.._ _-5---_.__.- Cesspool: Distance from nearest well-----------------Distance from foundation...------------__._.Linin material___....____..._.___.-__....__.__.-.-- g ❑ Size: Diameter.. _------------------ -------------=Depth------------- -- I-----------------------------Liquid Capacity--------------------------gals. t , Privy:l )_Distance from ne�est well------------------------------".-------------- --Distance from nearest building----------------------------------------- i ❑ Distance to nearest lot line-------------------- -------------- ----- - --------------------------------------------------------------------------------- Remodeling and/or repairing (describe)------C �-------------- ------ ------------------------------------------------------------------- t -- ------- --- -------------------------- ------------ I----------------- r--------------------- ------------------------------------ ------------------------------------------------------- -----------1------------ t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a r es and rcgulat')-ns of the San Joaquin Local Health District. ------ (Signed)------------------------------ ------------ ----- -- --- -- - -----,- _ Owner and r ontract -----------(Title}- (Plot plan, showing size of„lot, location,ofFsys+em in rrelat, too wel.ls, buiIj , etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY._ - - ----------- - --------------------- ------------------------------------------ DATE-----`L A_44 ---_1-------------------------- } REVIEWED BY--------------------------------------------- -------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------- -------------------------------------------------- DATE----- ----------------------------- ------------------------ Alterations and/or recommendations ---- ---------------------------------------------------------------------------"------------------------------- - -------------------------- ------------------------------------------------------.--------------------------------------------"-------------- --------------•--------------------------------------------------- -----•----------- -------------- ------ ------- ----------------------- ----------- FINAL INSPECTION BY:.._ Date.__-.___ ----- ® o 1 �"'"" 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.CC.