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FUK Vrrll„k USE: =3_ D 3 O - --- ------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------- ------------------------ ----------------- --- ---------------- ` (Complete in Duplicate) --- """---- -------- ---------------- ------ ----------- This Permit Ex ires 1 Year From Date Issued Date Issued 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 AND LOCATION__--__-, - -- -- -- - -- --------------------------------------------------------------------------------------- Owner's Name-._" _____ rt ---•- -------- ------------ ------------- ----------------------------------- - Phone.l� s__-_ � --- ------ ---•- ----------------- -------- ------------------------------••-- Contractor's Name----- ` - - ----- ---- ---------- Phone._�� YZ� Installation will serve: Residence ,-,., � i apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/_- Number of bedrooms -41-_- Number of baths -f--- Lot size Water Supply: Public system 0--communify system ❑ Private Depth to Water Table .� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: {If yes,date-------------_-----) No New Construction: Yes ❑ No -a/ HA/VA: Yes ❑ No ❑ v TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) No. of compartmentsneares- well---"_._.----_---Distance from foundation_..--_ --------------Material------------------------------------------------ Disposal --- ---- ---- - Nlk ------------------------------- i 2n.�,�.� Distance from -"._--__---" - Cj -------------Size --•--------------- -------•---Liquid depth.------ ------- ------Capacity---•--- --------- ----- Disposal Field: Distance from nearest well_Distance from foundation-"" ! ��:-- _".Distance to nearest lot line_""� _ Number of lines--------- - ` _ ;,� """ gth of each line---__-- --.- a pg "�� Width of trench �____ (� Type of fitter material-_- _ p}h of filter material"-__ , __ - -------Total length------- ---- -------- See e it: Distance to nearest well" -f Distance,- ,r � foundation"_-��"""___.Distan�e� to nearest lot fine_--�.""".__ Number of pits __..__"-"-__Lining material--"_- " _-� _-_-Size: Diameter._-___ 3---------Dept h......oZ ----------------- Cesspool: Distance from nearest well---------------"_Distance from foundation_----.- ------.Lining material--------__-----El _______ ------------ Size: Diameter------ --- •---- -------- ------Depth---------- -- --- - -- - ----Liquid Capacity-------- --------- ---------gals. Privy: Distance from nearest well""- ----- ------------ Distance from nearest buildin g ❑ Distance to nearest lot line""__.._.__-""_." ---------------------- 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, S laws and rules d r lations of tho n Joaquin Local Health District. a (Signed)------ -- -- --- -- ---------- (O ner and/or Contractor) By:---------------------------------------- �Lsysfiemin L- fo ---- --- -------(rtle(Plot plan, showing size of lot, location ofawells, buildings, etc., can be placed on reverse side), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-_ _--__-"_- ----------- -------- - ----- ------ ---------------------- - DATE".S-l?-�- - REVIEWED BY--------------- ......................------ ---- DATE ....................................BUILDING PERMIT ISSUED----------- ------ ---- ------------- ------- - DATE. Alterations and/or recommendations:--- � ` �? ��""" "" ----------- 5 �a' -"4.°----- ------------------ - -- ----------------------------------- - ---------------------------------------- -- --- - -- -- -- FINAL INSPECTION BY:..-. --------------------- --- Date ------- ------------- - ------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E,Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street } Stockton,California Lodi,California Manteca,California Tracy, California F.P.0 o.