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FOR OFFICE USE:. ------------ - _ APPLICATION FOR SANITATION PERMIT Permit No. .................... -------------_ � f ---- _ (Complete.in Vupiicate) i L ;, --------------------------------° � -- This Permit Expires l Year From Date Issued Date issued r_ .- 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 AN OCION------ ?.f---- �S1 f7- - -of------------------------------------------------------=-----------•------------------------------------------- IT Owner's Name-------- ----------------------------------------- - -- -------- ------------- Phone------------------------------------ Address----------------- ----•-------------------•-•-------- Address----------------- --------------- --------------------------------------------------------•-•---------------- - ------ ------ = , ` Contractors Name,,.. "=F,.` _ '� .---- ------•---- Phone---------------- ------------------ .-_ - � -------- 4', Ph .i O M ' '1 Installation will serve: Residence Apartment House-El" Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of diving units: --/-_ Number of bedrooms 4L Number of baths --- Lot size Z-_ - _1kVA41-1--------------------------- Water Supply: Public system �ommunity system j] Private ❑ Depth to Water Table + �ff. Character of soil to a depth,of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe qj--'l .ardpan ❑ Previous Application Made: (if yes,date--------------------) No [j-'New Construction: Yes Z?-No ❑ FHA/VA:!Yes g;�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Tank-or�esspoof permitted;if public sewer is'agailable within 200 feet.) �V • Septic Tank: Distance from nearest well------ ---Distance.frromdfoundation----O-__-.:"Mate ri a I_9:�-. %_ '___-.- -----. �� WNo. of compartments-----A-----------------Size-,"_--�+F �i�._.___Liquid depth--:-�/ ;Capacity--� ------ ---------- . Disposal Field: Distance from nearest well---------- Distance from foundation--.l49.---- : to nearest lot line--0_-__-. ®/° Number of lines------f------- ------„-.___.-Length of each line----Rig-�_------------ - - Width of trenchy�.----------------------------- --------------------------- Type ------.-------------- -- Type of filter material� 4�-Depth of filter material-----5$_fi----Tota€ length_-,_ -- -----------------_---._ x J r ' {\ Seepage P'st:. .' -Distance to nearest well-----�.----_---Distance from foundation---1_-1 --------Di�T e to nearest lot line-_ y` Number of pits_.__/.........----Lining material-_ .--Size: Diameter_ _- _---_._-__:Depth------__ .r�ii� . Cesspool: Distance from nearest well-----------------Distance from foundation-.- ___._-----------Lining material----_------__--------------.---.---. �] Size: Diameter--- -------------- -- -- Depth---------------------------------------------------Liqu i� Capacity---------------------------gals. Privy: Distance from nearest well------------------ -------------------------------- Distance from nearest building------.-------------------._-------- ❑ Distance to nearest lot line------------------------ - ----- ------------------------:----------- ell Remodeling and/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 and regulations of the San Joaquin Local Health District. �- -- ----------------- ----- - Contractor) (Signed)------- ----- ---------------- --- ------------------- By----------- ------------•---•----------- •-•---------------- ------ -----------�-------(Title)-----� .ejVL.....-.-. --------- h (Plot plan, showing size of lot, location of system in re on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- �-------------------------- - -------------------------------------------=-- DATE------'r fes= ---------------------------- REVIEWEDBY--------------------------------------------- ---- ----------------------- --•-- - --- DATE------------- ---------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------- ------------------------------------------------------------------ DATE---------------------------------=--------------------------- Alterations and/or recommendations:----------- ---------------------- ---------- � -------------•------------- -----•- -------------- --------------&�,_ - y= � ` a4' _ - ------------------------------------------------------------------------- �--- ------------------------------------------------------------------ --------------------- ----------------- --------- - ------------- :--------y ----- -- - ------- -------------------- ----------- ------------------------- ------------- -------------- --------------------- ------------------ --------------------------------------------------•------------- -------- FINAL INSPECTION BY------------------- ------------ SAN -•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ' 124 Sycamore Streetr N 205 West 9th Street Stockton,California Lodi,California` s� 'Manteca,California Y' Tracy,California F.R.C C.