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FOR OFFICE USE: 18 t ----- ----- 's---------- --� --- U Y-- _ l" APPLICATION FOR SANITATION PERMIT Permit No. -- -------------------------------- --- ------------ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a rmit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 JOB ADDRESS �OCTION !._ ----r--- -------- - - - --- - - ------------------------------------ Owner's.».Name------ __ Phona_ -_��-- Address----1_..3�-- [ 111 ---- --------------------------- •--- , --p Contractor's Name--------------- -- _ 1L�j` t -i Phone,[ •- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: ber of bedrooms _�ioff.?_ Number of baths _/___ Lot size _-_ ��_-____ .__. Z ---_-_ ;;<munify Water Supply: Public system system ❑ Private ❑ Depth to Water Tabled— f� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote......... ..........1 No ❑ New Construction: Yes ❑ N1--••FHA/VA: Yes [-] No E]TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publi sewer is available within 200 feet.) Septi Tank: Distance from nearest well . ___. -_Distanc7e from fou af�on_____/0___._.Materiai__ No. of compartments_...-..,7 _._ _ - p Dispo al Field: Distance from nearest well-................Distance from foundation___— --__-_----Distance to nearest lot line------______ Number of lines______ -------Length of each line.....J�___Q_r---------.Width of trench__' �---------------- Type of filter materia _ __-Depth of filter material__./;R. /� --------Total length_________________ nn �^ / s 5e agPit: Distance to nearest well_t1". ______Distanc rom foundation___.�2--�_____.Distzan`e to nearest lot lin ----------------- e ` Number of pits_.............. ...Lining material_ - , - ------ Size: Diameter -J3--------Depth-------------------- �^ Cesspool: Distance from nearest well_________________Distance fr foundation- - -._.____.____ _Lining material-------------------.-------.__-_-_-__ 6 ❑ Size: Diameter- --- --------------- ---------------Depth-------------------------------------------------.Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-.._. ------__----____________-.___.__-_. r ❑ Distance to nearest lot line-- --- ------------------------------------- ------------------------- ---------------------- ------ -------------------------------------- s = Remodeling and/or repairing (describe) --- ----------------- - ----------------------------------------•------------------------------------------------------ - -------------------------------------------------------- V ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------ ----------- ----------------------------------------------- ------------------------------------------------------------------------- ---------------------------------------------------------------------------------- ------------------------------------------------------------ 0 I hereby certify that I have prepared this application and that the work will 6 done in accordance with San Joaquin County ordinances, St f laws, and rules d regulations of the San Joaquin Local Healt District. 9 (Signed}__-- 11�--- L ( - -- Jr+� -- -------- - -- ------- er ontractor( BY:--------------------- ---- ------- --------------------- ------------ -- - - --- --- - ---------- (Title).---------------------- - (Plot plan, showing size of lot, location of system in rely ' to wells, buildings, et , can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - -�-- - - --- ---- ------------------ ---------------------------------------- REVIEWED --------------------------------------REVIEWED BY------------------------------------------- - ---- ------------------- ------- ---- ----------------------------------..------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED---- ---------------- - ------ ------------------ DATE-,-------- ----------------------------------------------- Alterations and/or recommendations:------- ___�r .`°.:f___-._.._._ __._ _ � �------------- `� `_ ---------------------- ----- ---------------------------------------------•-----...-------•.................. -------------------------------------------------------------------------------------------I--------------------------------------------- ------- - - ---- --------- - ------------------ --- ------ ----------------------------------------------------------------------- ------------ ------------------ -------- ----------------- FINAL INSPECTION BY:.. -- --- ----I----------- --- - ------ - Date---- --�- -- --- ---61 --- ---- /z----- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C R.