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FOR OFFICE USE- --------- - ------------------ -- �__ - ✓----.-_----- APPLICATION FOR SANITATION PERMIT hermit 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. JOB ADDRESS AND LOCATIO _... +� { ------5- u ------- _11__e-=---------------•---- E ; Owner's Name------------------------0 . - ----------------------------- ---------------- ------------------------------------- ------- Phone Address----••------------------ ....' Sa-- Contractor's Name----------\ 0�----------- r --------- ----------------------------------- Phone__... Installation will serve: Residence ©partment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: :-_-�-- Number of bedrooms ---_Number of baths )----- Lot size _---------_-------------------------------------------_--- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ks ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 2e-,Kdobeardpan ❑ Previous'Application Made. (If yes,date---------- ---------1 No ❑' New Construction: Yes ❑ No E4_-FHA/VA: Yes ❑ No 0— 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------------------------------------------_-----. OEn/rJ,-fr No, of compartments--------------------------Sizer-----------------------------Liquid depth--------------------------Capacity---------------------- Disposal Fi d: Distance from nearest well---=---_Distance from foundation_/4--_�__..---Distance to nearest t lin - -.-..- [ --�Z g of each line, -,/_------Width of trench---------- -------------------- dumber of lines-----_-- --__ I / ---- Length V1,AJ � pe of filter material----- of filter material---- _ ------------Total length-----Z_T_ ----------------------- Seepage t'� Distance to nearest well----------------------Distance m foundation-- ------------ Distance to nearest lot line-----14-_-----. Number of pits- .4-L.-L-9----.Size-. . Diameter._.?r2`�--.--.Depth__ Cesspool: Distance from nearest we€I-----------------Distance from foundation------------.-------Lining material--.-.------------------------------_-. ❑ Size: Diameter------------- -----.Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------i------------_----- Distance from nearest building______.-----..---------.---_-.-------.-. ❑ Distance to nearest lot line---------------- --------------------- -- -------------i--------------------------------------------------------- Remodeling and/or repairing (describe):_' ......... tr ---� -------------------- ---------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- ---------I-hereby certify that I have prepared this ------application and that the work will be done in accordance with San Joaquin County ordinances, guin•,Local Health District. Sta# ws, and rules and-r u ations o t e an oa � - (Owner and/or Contractor)- -------------- - - -(SI ned B `~�~~ -- r--------------- --- - -----(Title) �- �—"---- -------- (Plot plan, showing size of.l6, Iota ion of,system in relation to wells, buildirfgs, etc.,Tcan be placed on reverse side). FOR DEPARTMENT USE ONLY --- ---------------------------------- ------ --------------------------------- DATE APPLICATION ACCEPTED BY----._ - - G REVIEWEDBY--------------------------------------------- -------- --------------------------- ------------ ----------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------ r ------- -------.---� --� -- - DATE = ------------------------ Alterations and/or recommendations:-- --y U------- --------- ---------------------- ----------- ------------------- ---------------------------------------- ------------------------------------------ - ----------------------------------- -------------------------------------------------------- ------------- -------------- -•- --------- ------ ----------------- ------------------ ------------------------ ----------- ----- -----------•------------------------- -------/------ -------------------------------- Date. - ---------- ../__.-. - .- ---------- FINAL' INSPECTION BY:-_-----------=------ - � - ------ ----- �. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ka:elton Ave, 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California r.a.eo-