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FGR OFFICE USE: P ---------- -------------- -- Permit No. .�. Z � �a__,�� APPLICATION FOR SANITATION PERMIT - -- � r` -__ _ {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. eAj 4 _qq----------•------------ --- --- JOB ADDRESS AND LOCATION---------- -3-1-9------------- --- r --------- ------ - Phone------------------------------------ Owner's Name----------n ----- ---------------------------------------- Address -------------------------- - Address-----•------- ------` -------- �------- -- -`--------�---r--------- Phone b 6.7, .+ ` Contractor's Name------- 'r ------------------------- Installation will serve: Residence ['( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ y Number of living units: J----- Number of bedrooms __ Number of baths ---(---- Lot size --•--------•------- ----------- Water Supply: Public system �9 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 0ay ❑ Adobea Hardpan ❑ Previous Application Made: (If yes,date_.._-..__- —1 No X New Construction: Yes El No [� FHA/VA: Yes El No �[ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-------------------------------------------------- No. .___--No. of compartments--------------------------Size-------•------------------------Liquid depth--"-------------- - ------Capacity------ ---------------- r ---- --------y .well__..-_....__---Distance from foundation___________________Distance tot nearest lot line-_.------------, Disposal Field: Distance from nearest E] Number of lines-----------------------------------Length of each line------------------------------ Width of trench Type of filter material-------------------------Depth of filter material-----------------------Total length-----------------=.----------------------- 0A Seepage Distance to nearest well Distance from foundation___ r'____.Distance�to nearest 40# Gne.._.''r_�"---.- J I� Size -�------ Depth- -------- Number of pits--- materials_ �� Cesspool: // Distance from nearest well__..__."----___Distance from foundation------------------- Lining material---------------------- - --- als. UN Size: Diameter--------- ---------------------------Depth------------------------------------ --- ---- -----Liquid Capacity--------------------- 9 Privy: Distance from nearest well----------------- --------------------------Distance from nearest building-----------------------------.----------- ---------------------------------- ---------- p Distance to nearest lot line ---- --- ------ -------- --------- ------ ----•------•--_--------- ------------ ---------------- ------------------ -------- #� Remodeling and/or repairing (describe):--"---�} L� L � 3 i . .. ----____.____.__ k _-.._.__""---------------------------------"_-__-------.----__----- .--___..._____.__. 1 - ----------------- 1 ------------------------------ #k.. - I'hereby certify that I�have prep red this application and that the work will be done in accordance with San Joaquin County C ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r` `- ___(Owner and/or Contractor) (Signed) '------------------------------------ ----------- ,_ By:------------- ''" - -- --(Title)---------------- - (Plot plan, showing size of lot, location�o� s�e--Twin relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------_ • 1 1. j REVIEWED BY------------------------- ---------- ------=- -------------- --- ------------ --------------------— tions and/or recommendations: f----------------- --------------------•---------------I--- DATE BUILDING PERMIT ISSUED.____. I ------- ---- t..� .a Altera / --------• a - - - - -- - W --------(-�,� - - - ----- �- - .c � �►� ---�-�----- ---- ------- t ---------------- �- (� �- ------ -------- --------------------------- k - Rate.... ., ... ,. - s ---- --- ----------- FINAL INSPECTION BY:-.-.. � - ---- ------------------ ------ ------------ SAN JOAQUIN-LOCAL HEALTH DISTRICT 1601 E.HwLellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.co.