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FOROFFICE USE:: ------------------------- -------- •---------------- APPLICATION FOR SANITATION PERMIT Permit No: --- -------------------- -- -- ------------ ii (Complete in Duplicate) •.�. _ Date Issued ------------------_------_---_---_-----------------______ 'This Permit Expires 1 Year From 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 Or •nance No. 549. E6 JOB ADDRESS AND LO TION....-- -�------- ------------- Owner's Name- 'Q - -•--------- -------------- ----------- -- Phone------------------------------------ Owner's - Address--------14ip..._s?� _-_------_-- - ----------=-- '� ------------- c -------------------------------------------------- Contractor's --------••-----• --- --- ------ -Con+rector's Name = = Phone--- /FQQ3 ----------- Instaliation i will serve: Resi ence Apar House C;am er�aI railer Cour ❑ Motel ❑ Other ❑ ' Number of livingunits: ________ Number of bedrooms _ Number of baths _ Lot size __ __ ®® � ,3- A -- Water Supply: Public system ❑ Community system 0 Private ❑ Depth to Water Table/ ft. r Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay E] Adobe E] Hardpan 0 ,1 Previous Application Made: {If yes,date-----------:------ ._) No New Construction: Yes , No ❑ FHA/VA: Yes eJ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:. No septic tank or cess ool ermttted ' c s uhliever available Septi ank: Distance from nearest well-.905V Distance from foundation_.__ _-.-..Material- _..._ - � -d. No, of co ewFwtleT1'ts — _ rze ` - --- Liqur' del?h ----�J-`---/--------.Capacity r ' Dispos field: Distance from.nearest well-r�,5__Distance from foundation . 4 __.._.I]istance to nearest lot line,-/0 ,0.,_ - - Numberaf; lines__ � .__ f. _ Length of each lire....____7.5 __ _- Width of french--- __.____ Type o . ma+erlal ,[ .-------.--Depth of Pilfer mafie'rial_---.J �{otal'Jength-----�E�`�----------------------- ! f Seepage Pit: Distance to nearest well_.__._______________Dis+ante from foundation .____--______._.Distance'to nearest lot line__.._.______ ._ iter ❑ Num,b`erl of pi,fs---_----- Lining material--------=--------------Size: Diameter------------------`----Depth- -- -- ----------------------- Cesspool:' ---- -Cesspool:' Distance frnO nearest well_________________Distance from foundation....-_.._------- Lining material__.------------ ________._____--____.. ❑ Size: Diametei'------------------------------------- Depth--------- ----------------------------- --------Liquid. Capaci+y-------------;---------------gals. Privy: Distance from:nearest well_________________ ---------_-_____.__--________Distance from nearest building.__1_._._.__._______-__.______.__.-__..... . � El ------=----------------------- I Distance to ne�irest lot line----------------------------------------- --------------------;---- -I----------------'-------------------- # 1 , t Remodeling and/or repairing {describe)----------------- -------------------- ------•--•-----•------•- - I------------_-=--------------------- # ------ --------------- -- ----- ------------ ---. . F t -----------------------------------------. ____ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County:F;•,.. ordinances, State laws, and rules and-regulafions of the San Joaquin Local Health District. fS(Signed] -1:• -- —' a------------------- ----------------------- ' Ower and oh Contractor (Plot plan, showing size of lot, location of system in r afi o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY V APPLICATION ACCEPTI QI BY _ ...... _, -------------------------- DATE------- "" - ------- lz--r- ----- �t rr • k1%,�ti �, .ya.� •REVIEWED BY -------------------------- --------------- -------------- ------------------- ---- DATE ------ BUILDING PERMIT ISSUED' -------------- --------- --------- DATE----------------------------- ------ Alterations and/or-recommendations:--. = __r - = -------------- -'----- = i Vr:1 Tom, - ------ --- ------ -- ----------------------------------------------------- --------------------------------- --- ----- ------- - -------------------- ------------------------------I--------------------------------- ------ ------------------ ------------------------------ �•�- e � FINAL INSPECTIOi'dti�Y .- i = Date SAN JOAQUIN LOCAL HEALTH DISTRICT { 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Af - r.P.Ca.