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rUK U/HU USE: c ------------- ✓ ------- r 3 a-------------- APPLICATION FOR SANITATION PERMIT Permit No. . �� (Complete in Duplicate) l --------- ----- -------------------- This permit Ex ices.11 bear.,From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh'Disfricf for a permit to construct and install the work herein described. This application is made in compliance with County'Ordinance Ido. 549. JOB ADDRESS AND LOCATION_'. cJ�02 ' dlle1�_4 Owner's Name----- - } e -------- --------•-•--•-----•--------•----•-----••------•--•-- - - -------- --------- ------------------------------------------- Phone------------------- Address___-_-___:-� O__ f - ------- ----------•-----------•-•---------•---------••---------•---------------- ----••-------------------------..... ....... Contractor's Name_ - -----•---•--....15, 7- -------------------------------------------------- Phone---•---•---•---:...---••--•----..._ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court 0 Motel [❑ Other ❑ Number of living units: .-_-_ Number of bedrooms ____I s axjs-d Number of baths ___ .._ Lot*site _._'___ .__-_--••----__ Water Supply: Public system PP Y� uy [A -Community system ❑ Private ❑ Depth to Water TabbleLS? . ft. Character of soil to a depth of 3 feet: i Sand❑ Gravel ❑ andy Loam❑ Clay Loam,[) Clay ❑ Adobe Hardpan ❑ Previous Application Made: {lt yes,dai�e___________________) 'No New Construction: Yes�ErNo [] FHA/VA: Yes ❑ No 91---- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifpuAbl' sewer is available within 2QQ feet Septi�Tar kDistance from nearest we ___ _Distance from foundation.l .---_--,Material_____________________-- rn� No. of compartments--------------------------Size_------•--- ' -----•--------- ......... --.Liquiddepth- - Capacity I ----------------•-----. Disposal Field: Distance from nearest well_��F-------Distance from found ' n• .._.__.Distance to nearest lot line._6._�-_---_ Number it lInes fere -------- _______________Length of each line_ -------�d'---.Width of french--- f _ Type of filter mafieriaL_'-% d� ------.--Depth of filter material_________.-------------Total length_. ------------------------------- Seepage Pit: Distance to nearest well__.-_. _ _ hF______Distance from foundation__ ' Distance #'o nearest lot line_._____ [�— Number of pits._-. _____________Lining material t.S` ' + Size: iameter.ZaC�.--------Depth--- Cesspool: Distance firom-nearest we)l________________Distance from foundation-_____--______---_,.Lining material-.______--.-------------------------- Privy:: _______. ❑ Size. Diameter---- I------------------------------ Depth--------------------------- ----- -- --Liquid Capacity - ---------gals. Priv � �� i � - Y:: Disfance from nearest well------------------------ Distance from nearest building Distance to nearest lot line_.____--.__________________________ ^' t ,.. . g ----------•----------- -- - -------•----- El Remodeling and/or repairing (describe):--------------------------- ---------------------------------------------------- .---- --------------------------------------- .---------•--------------------------- ----------- --------•--------------------•--------------••--------------------------•-----•------- --------------•---- ------••------•---- ---------------------- 1 hereby certify that I have prep d this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a tions of the San Joaquin Local Health District. (Signed)-------------------------- By:. -- - --- -------------------------------------------------------- ------------------- (Owner and/or Contractor) ---------------- - -------------- in rela _ (Plot plan, showing size of lot, location of s tem tion to wells, buildings, etc.,.can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'-- *� F s�-< - DATE_ ��- I _G.- REVIEWED BY --------- DATE = BUILDING PERMIT ISSUED - --------------------------------------------•------ DATE--------------------Alteations and/or recommendations:.__________________--- ------------------- ------------------ -------- ------"-`----•----•--- -- -- ------------------------------.-.-.-.-.-.------1--•------•----------------------------- -> _ `� ,/1 - - 222--2------ ---��------ �- dam' �' �� -----� --------- _ ..;---�-•�•-•--------•----•----•-----•---- ----- ----- - ---- --- ------11------------- ------------------------ -------- _ ___ FINAL INSPECTION 'BY:__ -- ___. _-`J- -c �,� zp / Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street �: 300 West Oak Street 144 Sycamore Street Stockton,California 405 Wast 91h Street Lodi,California Manteca,California ca•a aevisco e• Tracy,California