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�,,M_PFFICE USE: ---------------- -------------------_------_------------_---------------- APPLICATION FOR SANITATION PERMIT Permit No. .1 ` ----------------- ----------- --------------------------- (Complete in Duplicate) -------------- This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh 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- dC , - �-- ---�►-------- --------------------------------------------------- Owner's Name-----------------� --/ --------------- Phone.----------------------------------- Address1 _eC.P ��.�_ d_�i" - -----------------•----•------- -- Contractor's Name_ / .t ----------------------------------------------------------- --✓ ---------..-----------------------------------•-------------- Phone �� `i Installation will serve: Residence [Apartment House El Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: __/--- Number of bedrooms __3_ Number of baths -//Lot size ------------------ Water Supply: Public system ❑ Community system ❑ Private ULoElepth to Water Table -------- ft. Character of soil to a depth of 3 fee<t:_Sand ❑ Gravel ❑ Sandy Loam E Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date___________________) No [Ao—New Construction: Yes ❑ No FHA/VA: Yes ❑ No �~ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool,ormiffed if public sewer is available within 200 feet.) t ` i Septic Tank: Distance from" nearest well_________________Distance from foundation------_-------------Material____._.____.______.____..-____._____..___.__..._. ❑ No. of compartmernts--------------------------Size--------------------------- ---Liquid depth---- --------- Capacity ---- Disposal F' Id: Distance from nearest well_! %_!_.---D�stance from foundation___�_._-----Distance to nearest lot Number of lines------------ ---------- Length of each line_______-�___--,--------Width of trench_.__ ___ Type of filter material___`� W_,0_G1:j)epth of filter material__f --------Total length-------.340___/,Or_-------------- Seepage Pit: Distance to nearest well--/ _-��Distaince fr foundation___.30--'------Distancg to nearest lot line-_.%...._�. [ Number of pits----/---------------Lining material5. � Size: Diameter----44r p s ' Cesspool: Distance from nearest well----------_:'_--Distance from foundation___-----------------Lining material--------___-___--__.____.___________� a ❑ Size: Diameter--------------------------- - _Depth----------------- .-- -------- ---- Liquid Capacity- --------------------- --gals. Privy: Distance from nearest well-_________________------_______.__________.__._Distance from nearest building------------------------------------ -.G El Distance to nearest lot line________ r_ Remodeling and/or re airing (descri1be):__ �-.- � _ -- ----. ------- _-�- ------ - -------------------•------------------------------------------ �.�_��i-�--------------------•V ' ---- ordinances, State laws, - es and regulations application li the San-- fh Joaquin e wo Heal}________ -_ -`- _____ c i _______ _ ----_- _ --- I � I herebycertifythat I have re pared this a lice+ion and-that +he work will be done in accordance with San Joaquin County(* 9 q h District. IO o l (Signed) �.�f�-, �.�._11 _ ----------- -----.(Ow er and/or Contractor) BY: - .._ -------------------------------------------------- Title { ). [Plot plan, showing size of lot, location o system in rely+ion to wells, buildings, etc., can be pla;eed on reverse side]. FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED DATE - /��Ilvj REVIEWEDBY-------------I----------------`-------------- ----- -------------- ------------------------- --------------------------------- DATE----------- ' BUILDING PERMIT ISSUED------------------- ----------------- -------------. DATE--------- ------------------------------------ Alterations --------------- and/or recommendations:` ---- /_ 4 �� y=1�/ ,- = = "."-== =,... = _._. . - - ------------------------------- ------------------------------- ------- ----------------------------------- r t . I ------------------------------- --------------------- -------- FINAL INSPECTION BY:____,� r - ------------ Date._.___._... dv ' --------------------------------------------- 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.P.CC.