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�►�i�' APPLICATION F A SANITATION PERMIT Permit No. ....1�.1..�..�:.... �j (Complete in Duplicate) Date Issued __.__!--__.___�� q Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. f *,+ This application isl made in compliance with County Ordinance No. 549. Ze JOB ADDRESS AND LOCATION_-__-- -- .--_ - Owner's Name 4--- - ------------------------------------------------------------ ------------ --------- Phone_ --- i ----------- ----- ---------- ----------- Address----��-- ----�G------ = ----- --•-••-- ------ ------ --- ---------------------- Contractor's Name--------- --- -• _ _-- - - --- ------ ---`--- - --- Phone.- Installation will serve: Residence Apartment ouse E] Commercial E] Trailer Court ❑ Motel Other ❑ Number of living units: _ _ Number of bedrooms /___ Number of baths _/_-_- Lot size .___ a _f. 'p--------------------._ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob4 Hardpan F]Previous Application Made: Yes E] NOX New Construction: Yex No E] / `, TYPE OF INSTALLATION AND SPECIFICATIONS: a„ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well.-;..............Distance from foundation-------------------Material_-__-----.-.--__-.______--___----..-..___-.... p -----------Size--------------------------------Liquid depth----------- - - --------Capacity----------------------- No. of com artments............... IDis4posaIR Distance from nearest well..................Distance from foundation----------------.--.Distance to nearest lot line--------_---_-. Number of lines----------------------------------'Length of each line---------------------------_Width of french----------------------------------- Type of filter material _-.._ -------_----------Depth_.of filter material---...--- Total length-___----__-_----_---__-----_--_-_____.._ _.-.-_-Distance from undation // Seeps a Pit: Distance to nearest welly _ !Distance to nearest lot line_ _ ._._ Number of its..../.................Linin materia Size: Di eter__ �� De th_ .-.---_-- p f 9 -: P ��--`�------- r- Cesspool: Distance from nearest well----------------- from foundation....................Lining material_______---------.-..-.--.__-_--____- ❑ -----------------Depth---------------- '--------------- ------Liquid Capacity- --------------------------gals. �. � Size: Diameter___________________ _ Privy: Distance from ,nearest well__------------------------- -------------- ----Distance from neareo building---------------------------__---._.__..._. ❑ Distance to nearest lot line----------------------------------------------- --------------------------------------------------------------------------------------- Remodeling ----------------- 1r Remodeling and/or repairing (describe):-- rye_ __ __ __ __ __ _____ __ _---- ------------- __ ---- -------------------------------- ------------------ ----- ---------------------------------------------- ----- W ------•-- ---------------------------------------------------------------------------------•------------- -------------------•-----------•-------------------------------•--------- --------------------•---------------- I hereby certify that l have prep red this applic tion a that the work will be done in accordance with San Joaquin County ordinances, St a laws n rules a r ulations o e S Joa "n Local Health District. (Signed)---- -- ----- --- ---------- r = (Owner,a dor Contractor) i By:....----_-- -- - --- ---- ---- ------ -- ------ --- ----------------------------------------------(Title)-- . . - . ---- (Plot plan, showing size lot, location of system in relation to wells, buildings, etc., can be placed on re arse e). FOR DEPARTMENT USE ONLY APPL��ATION ACCEPTED BY-------------------------------- -- - _ - ---------- •------- •----- --- - DATE-------- - ------ - -- --------- ------------------ - REVIEWED BY - ----- ------ ---- ------ ------------------------------- DATE_------ r —- BUILDING PERMIT ISSUED---------------------- -- -------- -- ----- ------------ ---- --- ---------------------------- DATE-------------------------------------------- ---.._..------- Alterations and/ recommendations------- -- ----- -- - - ------------------- - ---------------------------------------------------------...----•------------- ----------------- ------ --------- - ----•- ------- ---�T- --- .PEP—_T' f------- --- 95.....----- 4 r----•-F• AR1.7-/------------ :• I .. i ---------------------•---------- ------------------- ----------=- - -----------------------------------------------------------------------•---•------------ ------------•----------- - FINAL INSPECT BY Date------ -�W- � ------------------------------------------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 Arwpq❑