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FOR OFFICE USE: V,3X5— ------------ ------------ --- ...;3041� APPLICATION FOR,;SAN&TATION PERMIT Permit No. ,.g,.l ------------------ -------- - -------- (Complete in Duplicate) Date Issued --------------:-------------------------------------- --- This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, 01 LL JOB ADDRESS AN CATION----1' -! .7------ - ------ --------------------------------------------- 7- 7 i--- ,j 0 Address . . Owner's Name------- -------- -- --- ---------------------------------------------------- ------------------------------------ ... ..... ------------------------ •1V -------------- Contractor's ----.-cam_ -.- 7l- ----- ------------------ --•.-. Phone----------------------------------- Installation will serve: Residence!XrfmerLt Hous Y E] Commercial E] Trailer Court E] Motel El Other EJ Number of living units: --1--- Number of bedrooms :2--'7-Number of baths I---- Lot size .17- ------------------------- Wafer Supply: Public system ommuriity system n Private F] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam F-1 - Clay Loam E] Clay E] Adobeardpan El Previous Application Made: (If yes,date--------------------) No E] New Construction Yes El No FHA/VA; Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S is Distance from —nearest well--..-'.'—�-Dis't;ncefrot; foundation--------------------MaterlaJ-------------------------- -------- ------------- No. of compartments---------- ---------------Size--------------------------------Liquid dep.th ----------------------Ca pacify----------------------- ;e lose D (e Distance from nearest well__ M.,)Distance from founclation-Y---c�r....Distance to nearest lot line---- --------- Number of lines Length of each of trench=4W--"'f Type of filter ma`;e,iaIS .... ....Depth of filter length_________________:___- --- ,r I Seepa Pit: Distance to nearest well -----Distanc rO M T undati�on.iio!!�.�-..�.-.DisfaAce to nearest I f line---- I f ................ # Number-of pits_____ Linmg material. .. . _.__.Size: Diameter-_ ---Depth--- --------- 3-3------ C Cesspool: �"gta4nce' from-nearest,,well'-,,---------------Distance from undafion,-------- ---.-.Lining material-----.-------------------------------- Size: Diameter-------------- 4,-,-.-I.- • El - - -"Depth_-:----------------------------- - ------ --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-..........!�---------------------- -------------Distance from nearest building____________________________-_-_--_-__-_.,. ❑ Distance to nearest �of.line---------- - ---------------------------------------------------------------------------------------------7- ---------------------------------- ,we J1101— L Remodeling and/or repairing (describe)----------------_ N/------- ---- ---- ----- ---------- -------- ----- --- - ----- ---------------------------- ----------------------------I---------------- ---- -- ---- ---- --------- ---- ----- ---- - - -- ----------------------- -------- ------------------------------ --- r ------------------------------------------------------------------------------------------------------------------ --- ------------------------------------ -------------------------------------------------------------- ---- -- ---- -- --------------------------------- ----------------------11-------------------------------------------I---------------------------;---------------------- -- --- I hereby ece * y that I have prepared this application and that the work will be done in accordance with San Joaquin Cpynfy ordinances, S , e w and ruoNand regulations of the SanJ�' *tn Local Health District. J. ,e -Q��onfracfor) ------------------------------------ (Signe --- ---IL-- By:------------------------------------------------------------------- ---------- --- ---- -- -- -----(Title)------ - - -------------------- ------------- ------------------ (Plot plan, showing size of lot, location of sysfern'in relati to wells, buildin etc., can-be placed on reverse side)._ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- DATE ------ REVIEWED ----------------------- BY------------------------- --- -- ----- ------- I-------- --------- ------ -----------------------------�DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------- - -------------- Alterations and/or recommendations:-------------- ------ -------------- - - ---- --------=----------------------------------------------------------------------------------------------------------------------------------------------------- --- ----------- -------- -- ---------------- ---------------- ...................................... -----------------------------------------------------I -------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- -------------------------------------------------------- -------------------------------------------------------------------------Z---------------- --------------------- ------- - ------ ----------- - --- -- - ---- - ------------ ..............-----------------------------------------------------------------------;------------- ---- ---------------------------------- ------------------------------------ FINAL INSPECTION BY:..------- �------- ------ Date--- ----------- 7 -- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICj,,r 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CD-