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OR OFFICE USE:/ _..__..________ --------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. .1 ------------ - ---- -- ----------------------------- (Complete in Duplicate) --. -_ - --- This Permit Ex ices 1 Year From Date Issued Date Issued --- _ --�. Application is hereby made to the San Joaquin Local Health District for a permit to construct and insFall the work herein described. This application is made in compliance with County OVine No, 549. JOS AppRESS1D, C, TION_ ` i V ------------------- --- --------------------------- Owner's --------------- -- Owner's N O e---------------c.,---- ------------ ------ -- ------------- Phone__ 7��Wt. r a AcJdre ----- ---- - y -- Contractor's Nam -- - ------ ------------- --- , ------------ ------ -------•- -----••----------------------- Phone..11/6-------------------------- Installation will serve: Residence Apartment House E] Commercial ❑ Trailgr Court ❑ Motel ❑ Other E]Number of living units: ____I_ Number of bedrooms __�'__ Number of the _ _ Lot size /_ . --------------------------------------------------- Water Supply: Public system E] Community system Elate PrivDepth to Water Table __ __ t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe Hardpan ❑ Previous Application Made: Ilf yes,date__________________ 1 No E] New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ J TYPE OF INSTALLATION AND SPECIFICATIONS: ` o septic t sspool permitted if public sewer is available within 200 feet.} S an Distance from nearest well------------- Distance from foundation___________________Material-_____._.._._____- No. of compartments.---------------------1Size------------------- ------------Liquid depth--- ---------Capacity--------------------- f r� sa ield- Distance from nearest weli.�._�___Distance from foundatio __ � Distance to nearest lot line_____--6...--- Number of,dines---.-_�__ .__...__ Length of each line_- ._.. . - ._._-__Width of trench ,- ___________________ Type of filter material_ Depth of filter materiaL___.___1__ /__dotal length________ 't: i _" �f •Q'--------------- f coo 1 S e Pi Distance to Weare t well___.____,-__Dtstancerom f undation __ ___.Distance to nearest lot line_.__c _ s-. T I Linin materiaE__-_�______ --,2C? .�C� Number of pits--- ---------------- g '----.Size: Diameter--- -, - ---Depth----_&-f _ W (!�Wesspool: Distance from rearesf well-----------------Distance from f undation___-----------------Lining ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity---.------------------------gals. Privy: Distance from nearest welt-----------_--------_----------------- --- ------Distance from nearest building.__._____-______________________-.__..` ❑ Distance to nearest lot line---------------_------------------------------- I 1 Remodelingand/or repairing (describe)-------- --- -- --------------------------------•----------------------- ------ ------------------------------------------------------------------------ ---------------•---------------------------------------------------------- ------ ---------------------------------- ------------------ ------ ------------------------------------------- ----------------------------- 4 --------------------------I------------------------- ----------- ---------- --------------------- ----- ----------------------- ----------------------------- :--------------------------- ---- ----------------------------------- ----- ----- ----------- ----- ---- --' -- -------------------- ------------- -------------------------------------- .-- --------------------------------- I hereby certif tha 1 have prepared this applica ion d that t work will be done in acc rdance with San Joaquin County ordinances, St a S. rules and egulation of the S Joaqui aca alth District. (Signe -- -- ------------------ -{�Contractor) Title (Plot plan, showing size of lot, location of system i lation to w , buildings, a ., can be placed on reverse side). —� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---... .,--- -------------------------- -------------------------------------------- DATE----- REVIEWEDBY-------------------- ----------- ------------ ----------------------------------------------------------------------- - ----- DATE BUILDING PERMIT ISSUED --------------------------------------- ------------------ ------------- DATE--------------------------- 'Alterations and/or recommendations.:-------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ � 4 FINAL INSPECTION 6_� Y�� -� Pt<C __ date `2 I 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 q. 1