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FOROFFICE USE: -� / --------------/�` �� ----------------------------- ------------------".--.-.________- APPLICATION FOR SANITATION PERMIT Permit No. �F. ._----------.- --------- ------------------------ ------ --- ----------- (Complete in Duplicate - ; This Permit Expires l Year From Date Issued 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. JOB ADDRESS AND LOCATION... Owner's Name ,�L/- ; Qa-. U!• �f ---------------- --- ------------------=--------------------- Phone- Address hone- Address-------------•--------------c9�?.J?C`� , Contractor's Name-- .- ° - ��- jc--i._t.-. �' 'x Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ � Number of living units: --I---- N er of bedrooms -? __Number of baths --. Lot size _�f---_- _.l ----------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [( Gravel ❑ Sandfy Loam ❑ Clay Loam ❑ Clay E) Adobe Hardpan ❑ l Previous Application Made: .[If yes,date--------------------- No ❑ New Construction-. Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIO NS: (No septic tanP lp edif public s KDavailable al� _ f im"2 ,0., feet.)�. 14 Seitance� romnerestistancefomfoudation-------------------Material.------------------------------------- --------- . a # �'1'of com artmen - ----------Size------- ". ----- --------------Liquid depth---------------- -------.-Capacity------ - ---------- Dora 118- Distancejrom near st wefl__.____,- -Diltance-fro^ foundation--------------------Distance to nearest lot line--------------- - Numberto# lines = hg ac'h line- '------------- - -------Width of trench. 1'N yp r ___Apth off fi _--- N t _ w, # . 6 T e o filter,material-- :---- Distance ft iter material-----------------------Total length----------------•------------- ---- - I I See a Pit: Distance to Weare t well_r . ro foundation-- - -�---- }.is `�'�e to nearest I t line--. 'f 00 --- Number o pits__- ming mate6alo1?,,_ - ---------Size: Diameter- _ _.-----Depth- --------------_- ' � Cesspool: Distance ffrS ares weir.-Distance fr "foandation------------------- linin material-___ -----------------_I__--_.-. (� 9 Size: Diameter,_,-__ ❑ - Depth_ +� - q p Y I gals, S� - --- wd Ca acct - ---------------- � Privy: Distance from nearest well Distance from nearest bu ldtn - -------- ------ ----------- -------- - ❑ Distance to nearest lot Ione-- � '" -+ -------------------- --- Remodeling and/or repairing (descbe)•= ----------- ------ft__:w -• -------------------- - -----------------�.-"•----------------------- -------------------- W ; ------------------------------------------------------------ -- �- -- -----,- ---------------------------------- ,�. • - -------- ------------------------•----------------- Y---- ------- ----------------------------------------------------- -- --- 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, grid rules and regulations of the a'n-Jaacluih—t co a'1PH alth-Dis`trittf �. 0 (Signed)- l A-A - �- '1..� ------ - --- -----------------------------------------(�n»►�endfor Contractor] By: (Title)----------------------------------------- bplan, showing size of lot, location of system in relatio o wells, buildings a+c" can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE-------- �rP REVIEWEDBY------------- ------------------------------- ------------------------------------------------------ --------- ------- DATE---------------------- BUILDINGPERMIT ISSUED- '--------------------------------------------------------------- ---------------------------------- DATE---------------------------------------------------- .- -- Alterations and/or recommendations:- -------------------------------------------••-----------------; -------------•-----------------------------------------•------------ --- FINAL INSPECTION BY ------------------ ---------- Date----- 3 1""I &----- -- ---- ---- - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.r_O.