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FOR OFFICE U E: .S`v r'u w��„�.Q is �nc � w APPLICATION FOR SANITATION PERMIT Permit No. ,! --------------------------------------------------------- _.- (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. -Oso-� -.� - -•- - •-�---�•-----•- -- ---• JOB ADDRESS AND CATION__IQe l - `a ° 1 Owner'sName------ Address p --✓/ - - - Ph one Address-------------------------------c - -- ----------------•--------------•-------------- Contractor s Name--.-----•-�-Q -•-- '•--- ---- --------------- -------------••--•----•--------------- Phone ----------_ ••--------- Installation will serve: Residence ®Apartment House ❑ ' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_/--_ Number of bedrooms-- Number of baths -Lot size ---------�a --�� i4'--- ------------------ Water Supply: Public system ❑ Community sA=ravel Private [�6pth to Water Table �-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan i Previous Application Made: (If yes,date--------------------) No w Construction: Yes �o❑ FHA/VA: Yes B--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4,e �l��(No septic tank or cesspool permitted if public sewer;ixs available within 200-feet.l� cam,, -'f Septic Tank: Distance from nearest well---� ----.--Distance from foundation-�4----------. '---------------- �{, ----Li Liquid de th---�---------------- Capacity...-/-----"(1- �t•Y 3 No. of compartmen#s-----�r------------Size-- ..�'.----•----------- q P• Or / Disposal d_ Distance from neare t well.-- ---Distance'-from foundation-/------_--.-.---Distance to nearest lot Iine� 5-- Number of lines----- Length of each line--_81*� Q-P`--��----Width of trench.___- --�/- ------------------ y `� Total length- - b- --------------------------- Type of filter material---/ ��.-&cL�-Depth of filter mateclal__/ _ --.- ----- Seepage Pit: Distance to nearest well--------------- _---.-Distance from foundatiori--------_--..----.Distance to nearest lot line___----.-__---..: ❑ Number of pits----------------------Lining material----------- -----------Size: Diameter.----------------- ----Dept h-.------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--_.--------------..Lining material-----------.---------------.---.-----. ❑ Depth------- --------------------------------------------Liquid Capacity--- ------------------------gals. Size: Diameter--------------------------- Privy: Distance from nearest=we.11 --=---------------------------------------- _.-_-_,._-___.-Distance from nearest building--___----.----_---:------------.-._-.-... ❑ Distance to nearest lot line-------- ---------- ------------------------------------------------------------------- ' -------------------- --------- Remodeling and/or repairing {describe):---_-- -..��- -------- - ------------------------ - --- - --------------------------------• ------------------------------------------------------------------------------------------------------------- I hereby certify fhatLhave prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, StaW11aw , ales and latio s of the San Joaquin Local Health District. ------------- -------------------- (Owner and/or Contractor.)4 (Signed :�� ............... ----- -------------------------------------------- -(Title} (Plot plan, showing size of llcation of system in relation to wells, buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ----------- ----- DATE f W DATE--.--. REVIEWEDBY- - ----------- -------- ------ -------- - --- - -------------------------- -- -------------- ------------------ ---- --------------- -------------------------- --------- BUILDINGPERMIT ISSUED------------- ------------------ --------------------------------------------------- DATE- Alterations and/or recommendations---------------------------------------- ------•----------------------------------------- FINAL INSPECTION BY: PANiJOAQUIN <`^` ----- Date....... ' :. LOCAL HEALTH DISTRICT � 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.a.co.