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FOR OFFICE USE: r ------------------- 3 s ----- 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 Health District for a permit to construct and install the work herein described. i This application is made in compliances a we with County Ordinance No. 549. ; JOB ADDRESS A LOC ------- ------------------------------------------------------- ION_ r Owner's Name- --- - -- - - !� -- ------ Phone-0 Address , 1 gou-- �2m- `a C - -/' --.----•--------1111... Contractor's Name------ a ' -------------------------------------------------- ------------ Phone 3-- yY-- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer.Court ] M-�otel ❑ Other aj— Number of living units: -------- Number of bedrooms -------- Number of bath# __L.L/ C.�e. .7---------__________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tablel_-5— ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe HardpaJO P ❑ ❑ Y ❑ Y ❑ ; Y ❑ ❑Previous Application Made: (If yes,date...............__..) No New Construction: Yes L7 ��o ❑ FHA/VA: Yes ❑ NTYPE OF INSTALLATION AND SPECIFICATIONS: No se tic tank or cess ool ermitted if ublic sewer is available within 200 feet.Septic T k: p . Distance from earest well_. . _Distanc� from foundation_1()f Mateyial_ /1No. of com artments____ Size_�i�__f.L_X47Kj_.___Li uid de th____ ..-_- Capacity./,p?BdP q P.rt r Disposal Wield: Distance from nearest well- __ _Distance from foundation_aL�_1 __11_-Distance #o nearest lot line_________ Number of lines_____________ Length of each line___-fid _.W,Idth of f rench____ Total length--- QQType of filter -C./C.1-Depthme �tof filter material... / �Q _;__-_-__.._ _-_-_-_-- See - I Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line._.__-___--___.__ Number of pits----------------------Lining material-----------------------Size: Diameter------'• !l Depth------ - 11 - 11----------------- C materialCesspool: Distance from nearest well_____________.__Distance from foundation___________________ Lining .___...........----------------------- FJ' -_-_._________.______-❑' Size: Diameter---------------- Depth uid Capacity__......1---------------9als.iIM Privy: Distance from nearest well-----------------------------------_-------------Distance from nearest building_.....__...____________________-_____. ❑ Distance to nearest lot line-------- --------------- ------- --------- ---------------------------- k ----------------------- ----------- Remodeling and/or.repairing (describe)_-, . ---------------------• ---------- - - ---- -----ti ---- ------------- --------- .. -------�I -------- J--------- ---- ----- -------------- ---- - -------------------- --------------------------------------------------- --- ----------------- ----------------------------- ------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County $ ordinances, State laws, and�ules nd gulations o4thean Joaqui�i Local Health District, i(Signed)------- ------------------ - - ---------- -- - --------------- -PcFe!d .... ner and/or Contractor) gY:------------------------------------------ -- ------- ----- ----------------(Title)- -- -------- - ------------------ ----- (Plot plan, showing size of lot, location of system in rela , buildings, etc., can be pnreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-. I '1� �� DATE ----------------------------- ---- - - --- ----- ---------------------------------------------------------------- REVIEWEDBY---------------------------- ----------------------------- ----------------------------------------------------- --------- -------------------------------------------------•----- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.- ---------------------------------------------------------- ----------------------------- ---------------------------- Alterations and/or recommendations:_--- ----- ----------------------------I--------------------------------- - ------------ ---------------- - ---------------------------- ----------------------------------------------------------------------------------------- I ------------------------------------------------------ f --- ------- ----------------------------------------- - ---- ---- -- ------- - --- ----------------- -------------- ---------- - ----------------------- ------------------------------------------------------------------------------------------------------------- --- -- -------------------------------------------------------------------- ------ ---- --------------------- Date ` -� 1 FINAL INSPECTION 8Y:-�M-�--------------------------------- � U SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street �! 205 West 9th Street Stockton,California Lodi, California Manteca,California !i Tracy,California