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FOR OFFICE USE: __ _ APPLICATION"POR SANITATION PERMIT Permit No. --------------------------- ------------- ------------------------------ - ------- (Complete in Duplicate) -_-_------�____---�� ------------ -------------------------- ----------- ---- __. I This Permit Expires .1 Year From Date IssuedDate 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-eompliance'with County Ordinance No. S49. JOB ADDRESS D LOCATION----- f�f - Owner's Name - -- -- Phone------------------------- ---------- Address----------- •--------Address-----__-.-•_ --- -- -- ---------------------------------------•--------------------------------------- - Contractors Name---- -/ � Phone Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ` Number of bedrooms _-J--_ Number of baths --a`---- Lot size ------------------------------0' 'Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tablet. Character of soil to a depth of 3 feet: Sand E❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0' Hardpan ❑ Previous Application Made:`{iff r ,--elate:----___..=)' No ❑ New Construction: Yes [B' No ❑ FICA/VA: Yes R�" No ❑ • TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) o. Septic Tank: 'C Distance from nearestje _--��- _Distance fromfoundation__._/___0---___._.Material_e_�_�__ ��-'---------------Is. , No. ofcompartments- ----- -_Size- de th_. i Ca acitD_ q p. p Y Disposal Field: Distance from nearest well - -----Distance from foundation..---------.Distance to nearest lot lin e_.__ Number of lines_____#__.--- ------Length of each line�W, __e "-.Width of trench-------------------- Type of filter material.,irAF c._.-Depth of filter material. ` .........Total length-40 �---------------_-Seepage Pit: Distance to nearest well_-/�w`___--Distance from foundation---/��_-__.Distance to nearest lot lined-:' [�' 1 Number of pits._.--------------Lining mate ria l___��_-Size: Dia meter-_��___.__.-----Depth� �igr1�� Cesspool: A Distance from nearest well-----------------Distance from foundation-------.-----------.Lining material_-.-_--__---_-__.__.______-_-_ ; ❑ J Size:;'Diameter------- ------------------------------Dept h---------------- - ------------ --------------------Liquid Capacity- -------------------------g Privy: Distance from nearest well ------------------------------------------------Distance from nearest building__________.________-_---__-_-.-.---_..._. ❑ r Distance to nearest lot line- -------------------------------- -------•-- ------------------------- ----------------------------- --------- - ------------------------- Remodeling and/or repairing (describe):------- ---------- ` v ------------- --------------- - - f---------------------------------------- ----------------------- ------------------------------------------------------------------------------------------------------------------------------ ________-_-_____-.-____ - ________________ S._______-.__.__-_--___________ --_-_______.__-________----_------_______---_-_- ---______--------__._----_________-__-__-____..-.---_---_____---------------- I hereby certify that I Ixavee prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws! and 'rules an• regulations o'f+fie San Joaquin Local Health District. --------- (Signed) -�f or Contracfiar), Y ----------- ----- i B buildings, --- ----[Title) l s ---------- (Plot plan, showing size f lot, location of system in relati o wells, g , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -------------------------------------- ------------------ DATE- 4-S--' REVIEWED'6Y-------------------------------------- --------------------------------- - -------------------------------------------------- DATE--------------------•---------------•----------------------- BUILDINGPERMLT'ISSUED-------------------- ------- ------------------------ -------—-------------------------------- ----- DATE----------:------- -- Alterations and/off ecommendations:--) ----- ------ ----- - - . ------. .---- --- -- -+ -------------------� '' -------------------- --- ---------------------------------------------------------- ----------------------- -------- ----- -------- ---------------------------- ---------------------- ---------------------:---- I FINALINSPECTION BY;.,-O- ----------------------- Date------ '.t 4 4 .!P�.---------- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Ha:ellon Ave. 300 West Oak'Street s ,tet : .Ti , ; 124,Sycamore'S+re't I � 205 West 9th Street S Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.