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F R OFFICE USE.. APPLICATION FOR SANITATION PERMIT Permit No. �_____. ---------------- --------------------- ------------------- (Complete in Duplicate) Date Issued _______ ___ ___ This Permit Expires 1 Year From Date Issued 1 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. 544 9 JOB ADDRESS AN OCATION_....�� =- -f---6- il.----W�l--------- ------------------------ Owner's Name-- 1. - �_� 1� Phone-- Address--------------------------------------�` Wim- — ----- ------- •- -----------------------------•----------------------------------•--- -Ly Contractor's Name----.J_fes--- _ F' ' 4 t �. ' �1 �1 �1 Phone Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----f Nu ber of bedrooms 3- Number�of baths 1-. Lot size �__�- __.�- - ------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe Uj,�ardpan ❑ Previous Application Made: (If yes,date--------- __..} No ❑ New Construction: Yes ❑ No W1_1FHA/VA: Yes ❑ No ❑ , t q TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 2OO,feet.}y $ ? Distance from nearest,well-_.--------.-- Distance.from-foundation--------------------Materiai-----------__-_._-.---_-._--------..----.------ l R 44 No. of compartments Size----------------------------- Liquid depth Capacity ' �I Distance from nearest well Distance fromfoundation._/*_—____._.Distance-.._'.Distance to nearest # ii a-`_` _mow l ` / Len th of each line----_ Width of trench__.__Xi►-__- L� Number of lines------1--- -------T-- - _ 9 d �-�------`� - �---- s= `rlf �� Type of filter materialof _:Ic- . epth of Tilt' material----._.>< T_otal length___________________________ - _._. . .- o, Se Distance to nearest well_ �� __,_ L --__Distance from foundation---'� _.Distancetto nearest lot line--_--` Number of pits----1----------- �_L'ining material_gP ......Size: Diameter-- epth------RAC-------`-_ Cesspool: Distance from nearest well--- -------------Distance from foundation__..--.-_-..J......Lining-material-_.._-_---.---__.._.._.-_---_------ J ,.w.� ..- :r_. ❑ Size: Diameter--'---- ------------------- ---------Depth---------�-- i "'=� Liquid Capacity----------------------------gaIs., Privy: Distance from nearest well-__--..--.-_-----------------------------------Distance from nearest building____---_------.----------__---_-_..___:l":. ❑ Distance to nearest lot line---------------------- ------- ------------_- ------- -4 ------ -------f'--------1 ----------------- ---- ' i ---------- ----------- --------------------------------------- Remodeling and/or repairing (describe:____ � ir - ---p� ++ y jtj ` ,- ---- -------x------ f_ _ =_ ------------------- -------------- ---------------------------------------- ---------------------- --- - i I ------------ --------------------------------------------------------- - ---- - ---------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan s, St aws, nd rules and re ulations of the San Joaquin local Health District. y / " T17 �� (Signed)-----�- ----- J = / $ wn r Contras#or ------------------------•--------------------------------- -/i? -(Title)_,-w --------- ----------------- (Piot plan, showing size of lot, location of system in relation t ells, buildings, TC., can be placed on reverse side). j 4 -- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- ----------- - - --- -- -- -lC�--- DATE---- -- -- ---------- REVIEWEDBY--------------------------------------------------- ---------------------------- - --------------- --------------------------- DATE ---------------------------------- ---------------- BUILDING PERMIT ISSUED - r----- DATE---------------------------------- ------t------------------ Alterations and/or recommendations:._..__��l. .._� -Cl'� / '�' - -------•------ 'i'�" -`' �' -/ y - G — �G� `�`-------- – ' – X --------------•--------------------------------- --------------------------------------- ------ % ----------------------------------- ------------------------------------------ -------------- ---------------------------------------- ,...4 .. --------------_ - -------------------------- - --------- --------------- — l FINAL INSPECTION BY: .. _ - --------------- Date- ----- G ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California i ..