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FOR OFFICE,USE: ------------ ------------- ---------------- ------------ -------------------------- APPLICATION FOR"SANITATION PERMIT Permit No. . .�� ✓ -------------- --------------------------- ------ (Complete in Duplicate) ---------- --- This Permit Expires 1 Year From Date Issued 3 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. t��p�p�+p• SV f &TI{ RC7 P JOB ADDRESS AND.LOCATION._'-_ JI_I� -_ _ � __� -n---- - f -� �Q Owner's Name-------•---------•---- &x-------------!_-1_ fTo-�------------------------------------------ x' --------- Phone------------------------------------ Address � --------.. ------ ------------------••---------------------------•--------------------------------------- Contractor's Name------ - Q_LV lr� ----- --------. Phone----••- ---- . ._ ._ • •--- ------•---------- Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court E] ,Motel ❑ Other ❑ g �� .Z S ---------------- Number of living units: __�____ Number of bedrooms�,�Number of baths __�___ Lot size ____ __ _�. Water Supply: Public system [-Community system ❑ Private ❑ Depth to Water Table--------- ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay p � ❑ Y ❑ y ❑ y ❑ Adobe ❑ Hardpan ❑ � Previous Application Made: If yes,date......______--------) Nor.[ New Construction. Yes ❑ No [J�FHA/VA: Yes ❑ No -, TYPE 4F INSTALLATION AND-SPECIFICATIONS: .. (No septic tank or cesspool_permitted if public sewer is available within 200 feet.) G!7y WATL . Septic Tank: Distance from nearest well_._. --Distance from foundation----l --------.Mat rial_-_ _ -- -- ------------- ------------- �`9 Liquid depth / 2`-----Capacity--------� No. of compartments._.._ -.�_____________Size__ ____..___ -- D-------- Disposal Field:Field: Distance from nearest well.C- ---_Distance from foundation___:__ _ --� �0-------Distance to nearest lot lino---s— Number(� - _ of lines---------- g f � 2O 30 . of trench- __- -_--__�-_- . ii. .f- TYPe of filter material____ ---Depth off'ltermateriaI --------------Total length ------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line----------.__-_-- ❑ Number of pits----------------------Lining material---_-------------------Size: Diameter------------------ ---.Depth--------------------------------- Cesspool: Distance from nearest well-________________Distance from foundation___------------Lining material ----.__----------_-______.__.-_--__. ❑ Size: Diameter-- --------------------------------- Depth---------------------- - --- - - -- --- --Liquid Capacity_--------------------------gals. Privy: Distance from nearest well.-__________________________.______._._..____-_Distance from nearest building-------------------_----------__------- ._. ❑ Distance to nearest lot line-------- ------------------------------------------------------------ RemodelinAand/or repairing (describe[:-------------------------------------------- ----------------•---------------------------------- -------------------------------------------------------- ----------------- -------------------------- -- ---------------------------------•-------- ---------------------------------------------•------••----------------------••-------------------------------------- - 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, and rules a_rLidl regulations of the San Joaquin Local Health District. (Signed)----------- � ---------------- ----- {Owner and/or Contractor] - -------------------------- gY--------•---------------••------------------------------------------------- ---------------------------------------------------------(Title)-------------------------------------- ---.---------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - t®----------------------------------------------------------------------- DATE--------- REVIEWEDBY----------------------------------- -------------•--- DATE------------------------------------ BUILDING ----------- ----- -- Alterations and/or recommendations:---------- — — -------------------------- DATE UILDIN PERMIT ISSUED------ ----- --- ------------------------- / / 3 . — ---':l �' 0_� I'. 5------tv/J-k----- �7_A_1 rr�}soar=------------�'--A_-0------------- ' k ------------------------------------------------------------------- - r ' X12~ � c l-f .. inr X5"1 -- -------------- ----gip; Ap R9 -------- - ---- ----------------------- C PrMAaE HERE lI<r . T - -roLi> . . nfr,r j�5rErv1 nlor ta, Co pv.' 0 �1> [ aC. �r w rl,._ r_WYHFko 1' C-17 S!W f-FC 5 67 A/ � ��)3��-�ry�r �s.EA�� FINAL INSPECTION BY:.14�---COI1Pr- T" ---/-A- -- 5HQWf�4 ------------- N J A AL HEALThi DISTRICT `�( - 160�Iton Ave. 300 est Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California- ;r-� F.RCO.