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1 rUKUrr1C.1: USE: {O1 ° 4�fo� - `- ----- _ -------- -- _________-------- APPLICATION FOR SANITATION PERMIT �– Permit No. ......t_-7------ I {Complete in Duplicate) -------------------------------- I fort This Permit Expires 1 Year From Date Issued bate Issued - --30E r� 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 t TION --- •---------------•----------- Owner's Name___________ ____ --------------- Phone.---------" .-� ----- Address ------- ------ Contractor's Name._ F �h ��k f� `�'. -- --- -------- - --- -- ----- -- ----- ------- one---•'-`�•"-`•- --- - '�` Installation will serve: Residence ® partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -��mmun'ity mber of bedrooms -?,--Number of baths --� Lot size Z_.� Water Supply: Public system system ❑ Private ❑ Depth to Water Table _Kaft. 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 ❑ NoHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I No septic tank or cesspool permitted if public-sewer is available within 200 feet.) S Ta Distance from nearest well-----------------Distance from foundation___________________.Material__________--__.______._ __- ------------------ P No. of compartments ----- -----------_--Size---•---------------------- Liquid depth--------- --------- -----Capacity--•------- ------------ sal� , : - Distance from near st well�Iiklq�Distance from foundation-__ f _ ___._.Distance to nearest lot line____- ---- e Number of lines-1-- ___ _-_.___.-'_ --____Length of each line__3_�1_r-----------.Width of trench. _!� p dU/ Type of filter materia��---Depth of filter material--_-------- -- _l� Total length------•----------:----- �-__-- SWe ' Distance to near st well_ :7--Distance from foundation_ ._ __._.Distance to nearest lo# line_____--- Number of pits._)__________________Lining material-Rad --__--..Size:`viameter-_ 000 , �� .Depth /] t = r Cesspool: Distance from nearest well-_______________Distance frorrf foundation------_____-______-,Lining material__----____.._____----___.------------ Size; V rO ❑ D�iameter---------------------------------------Depth----------------------------------------------------Liquid Capacity- -------- gals. PPriv . { rivy- Distance from nearest well------_-----------------------------------_------Distance from nearest buildiri ❑ Distance to nearest lot line---------------------------------------------- -•--------------- -------------------------------------------------------------- Remodeling and/or repairing (describe):___-__ '� ~' ------------------ ---------------------------- -x( ---- ------- ------------------------------------------------n--------- --f-- --- -------------- ----------------- ---- _. - __ ---------------- ------ r ----- ----------------------•------------------ek] hereby certify that I have prepared this application and that the worke done in accordance with San Joaquin County ordinances, St a la S. nd rule andFregulations of he San Joaquin Local Healt District. [Signed f'�,t - '- --�-- ---- - ��=1 �s.�_ r Fo��----------- Contract 1 ------------ •--- or) By:--------------------------------------------- ------------------------ ----- -- - -- - --------------- (Plot plan, showing size of.lot, location of system in relation o wells, buildings, an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.,CY__. 3------------------- }- __- ------- ------------------------- DATE---- b'�' �'� REVIEWED1. BY ---------- --------------------------------------------------------- DATE ------------------•-------------------- BllILDING PERMIT ISSUED --------------------------=--------------- ----------- DATE --- ----- Alterations and/or recommendations:._____ �- --------- 1 -------�-r--- ' ------------------ -- --�--------------------- Alterations -- ------ --- ---------- ---- ------ - -------- � 9:--- ------ ------------------- �---- - FINAL INSPECTION BY:------ Date...._-- --` f 7f 2� i ----•---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. . 300 Wast Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVIrto 0-59 3M 3-163 F,P.CC. �y f