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1-UK Urr1C-E USE. _. ------------------ -- ----.-..--__.3; .�--- APPLICATION FOR SANITATION PERMITPermit No. . -------- -------------- -- -------------- --- ,. (C-amplete in Duplica jel ------ ------- This Permit Expires 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. r JOBADDRESS AN9 JOCATION-----,--- -*A----------so--------�. ------------- ------------ ---•----------------------------------------------- Owner's Name--------- -)------ ------ - ---- Phone-------------------------------- - -------------------- --- - ------------ -------------------------- - --- Address � --- ------ � yL� Contractor's Name--------I------ --- ��}�Lw-------------------------------- -------- --------------------•----------------------- Phone--------•-••----------------------- Installation will serve: Residence) Apartment House E] Commercial [:] Trailer Court E] - Motel Other'❑ C - Number of living units: -- ---- Number of bedrooms - - Number of baths _-j---- Lot size Wafer Supply: Public system ❑ Community system ❑ Private [❑ Depth to Water Table -- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel n Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe ©hardpan ❑ Previous Application Made: (If yes,date--------------------J No [V New Construction: Yes Er"N`o ❑ FHA/VA: Yes ❑ No S- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----—---.._ Distance from foundation_-/a..........Materia1__._A__el--------------------------___-. [ No. of compartments--------Z-----------Size--?- -5- (- -------Liquid depth-------y_??-------._.Capacity- ------------ l Disposal Fieicl: Distance from nearest 'well ""` Distance from foundation___/.0-_ :_:Distance to nearest Iol line--- --.----- Number of•Dines--_------I------------------------Length of each line-----yd---$-----_------Width of trench__ S' Type of filter material---1[,�__--ka�frUepth of filter material----�_ _'I-------.-Total length---.-- Q-,�--------------------- 4-110 See a it: Distance to nearest well---------- -------Distance m foundation----/A-_f_. Distance to nearest lot line�f-.------ 0 p g 3 ----------Depth------S tt Number of its__-.-f.___-.----.- Linin mate ___ -__-_--Size: Diameter_- i/ ' _-- � Cesspool: Distance from nearest well-----------------Distance from foundation---.--------------- Lining material---------------------------.---------. ❑ Size: Diameter--------------------------------------Depth--------------------------------- - - -------------Liquid _Capacity----------------------------gals. VN Privy: Distance from nearest we]-------------------------------------------------Distance from nearest building______---.------------------_____.------. ❑ Distance to nearest lot line------------------------ --------------------------------------------- Remodeling and/or repairing (describe):- .- --- , -- --/ --�- --------- ------------------------------------------------ ----------------------------- �----------- ------------•----------------- -- �. -` --------------------------------------�----.----------------------------------I---------------------------- ------------ -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la d rules egulations of the San Joaquin Local Health District. (Signed)------ ----- -------- - - ------------------- -- ---------- - --- ------------- ----------------- --------- ---------(Owner and/or Contractor) BY=-------------------------------------- _ --' Title ----- - (Plot plan, showing size of lot, loc do f system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....__,- -? 1. .__.__._.-. DATE__ ------- ----------------- ------------------- ------ REVIEWEDBY--------------------------------------------------- - - ------------------------------------------------------------ DATE--------------- BUILDING PERMIT ISSUED----ti-------------------------- -----------------------------.-.-_-_---_- ---------------r------------------- DATE---------- Al �tons ador re;crom ndations:_-.- ---- -- ----------------------------------------------------------------------------..................t---- --- �. - -------- ____ ��''-� �='�--- --�-- - - -------- - - --- ---------------- ✓' FINAL INSPECTION BY--------- ----- --'�------------------------------------- Date---- f. SAN JOAQUIN LOCAL HEALTH DISTRICT . , 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5 Stockton,California Lodi, California 'Manteca,California Tracy,California F.P.CO.