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FOROFFICE U5E; ----------. - APPLICATION FOR -SANITATION PERMIT Permit No. ..7�_ J�—� ` (Complete in Duplicate) - ---------------------------- ------------------ --------- Date Issue ------------------------------------ This Permit Expires 1 Year From Date Issued w 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 Oil inance No. 549. JOB ADDRESS ANP LOCATION-----/__------ - -,---- ----------------------------------------------------------------------------------- Owner's t------------ ---._ Phone-------------------- --------------------------------- -------------------------------------- --•------------ Addressy ---9-- _�_/----------------------------------------------- -----••----------------------------------------------------------- ContractorsName �__ ---� « ------------------------------------ - ------------- ----------------------------------------------- Phone.------------------------•---- --- Installation will serve: Residence El-"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _5-__ Number of bedrooms____ Number of baths____ Lot size __S. x./tea --------------------------------------- Water Supply: Public system _-Community system ❑ Private ❑ Depth to Water Table _4rt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0---Hardpan ❑ Previous Application Made: {if yes,date__..................} No New Construction: Yes ❑ No er'FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' ank: V-� Distance from nearest well-----------------Distance from foundation------------------- Material_.__________._.____-._______________-.___._. No. of compartments-------------------------Size--------------------------------Liquid depth---- -- -------- Capacity----------------------- Disposa R Distance from nearest well-----p --------Distance from foundation--- to nearest lot line__4�.... Number of lines______._ __-____._Length of each line---S_s7__f______________Width of trench_ __ -_____._____-_._ � �, Type of filter material----jli7�_.0......Depth of filter materiai/9__9_____________Total length____- 7a.�_------------------------ See�paP'( Distance to nearest well---'--------------Distance from foundation___f_�-----------Distance to nearest lot _____._ R�c� of fff Number of pits___!1______..______Lininq material___��1.6.'_.Size: Diameter._.._ �_._.-___.Depth__._____v..C_��____.____ Cesspool: Distance from nearest wei€-----------------Distance from foundation.-.---------------- material__..-.-.............--_._________.___ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------- --------_-------._____Distance from nearest building_______----------------------------__- ❑ Distance to nearest lot line---------------------------- ---------------- -•--------------------- ---------------------- ----------------------------------- ------- Remodeling and/or repairing (describe)--------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- - ------- - -- I hereby certify that have prepared th' p [cation and that the work will be done in accordance with San Joaquin County ordinances, StatVlaws, d ru and regul of the an Joaquin Local Health District. (Signed)-------------- --- ----- ------------------------ --------------------------- - -----{Owner and/or Contractor) By:_------------------------------------ ------------------------- _---(Title)--------- - ---- --------- ----------------..................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DE ARTMENT USE ONLY APPLICATION ACCEPTED BY / ---------------------------------------------------- DATE--------- - ff REVIEWEDBY-------------------------- ------------------ -------------------------------- ---------------------------------------------- DATE--------------------------------------------------------- BUILDING PERMIT ISSUED----------------- �'------------------- DATE--------------------------- ------------------ --------- Alterations and/or recommendations:.______ E'_.'`z�__ ✓!_ _____ ____________________ ---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------- -- ---------------------- ------------------------------------------------ ------------------------------------------------------------------------------------------- -------------- ------------------- --------- ----------------------------------- -------- ------------------------------------------------------------------------------ -----------------------•-------------•----------------------------------------------------------- FINAL INSPECTION BY: �` ------------------------------------ Date _ - ��---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California