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FOR OFFICE USE: -------------------- - ----- .---------------------- APPLICATION -------.._ .._ - APPLICATION FOR SANITATION PERMIT Permit Noa ------------------------------------------------ --------------------- - ------------ -- --------- (Compliefa in Duplicate)licate) 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 nd 'nstall thew rk herein described. This application is made in compliance-with County Ordinance No. 549. N `� SU- 3 Z // C_6-----fir ` JOB ADDRESS AN LOCATION-----Z�--------------------- -`--p-------`,-------- -- - - ------ - - - �/... Owner's Name--(:f-- -------------------- Phone_ ti= Address------------------------ 67 ---- •----------- 1- ----------------------------•-•--•------------4-----a----d. .¢.--_-.-- "- -- -- Contractor's Name_____ -- - ----- ------ •• - --- --- ------ --- ------ ------------ ------------------------------ PhoneA/%-----,�!�.r Installation will serve: 'Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms __ _ Number of baths ---/_ Lot size ____ ---- ------__________________ Water Supply: Public system ❑ . Community system ❑ Private jK Depth to Water Table AQ_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------.----_--) No [ New Construction: Yes ❑ No DHA/VA: Yes ❑ No ❑ TYPE�O.FtINSTALLATION,AND,SPECIFICATIONS (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well-- ...... istance from foundation d _ -_--_.Material_ : No. of compartments_.__. -_____�_._r5izey ------Liquid depth-.y__________________Capacity__/a4a___ ._ Disposal F" Distance from 'nearest well.>�-- ......Distance from foundation___lGJ_ ._..Distance to nearest lot line_------ -' ----- ---- -----------Length of each line__--- _----' " " Width of trench.---- -�--- ___-...__________--_ Number of lines_._._ g � --- - -- ----- � f Type of filter material___sSz*,0L_/�__Depth of filter material-_--,/_j----------Total length------------------------/. __-.- Seepage P& Distance to nearest well----------------------Distance from foundation--------------------.Distance to nearest lot line----_.'______..._ ❑ Number of pits-------------- .......Lining material-----------------,-----Size: Diameter-----------------------Depth-------:----.-------------------- Lni Cesspool: Distance from nearest well_________________Distance from foundation_____._.------------Lining . material---------------------_------------- ------------- :Depth _ :: -.Liquid Ca acitY gal LA. LASize: Diameter 1771 ��• - '- --- � �.-err - Privy: Distance from nearest well ______ ____ _____________Distance from nearest building______ _ -__..___ __________ _.__._. ❑ Distance to nearest lot linea- ------------------------------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing {describe):------------------------------------- -----------------------•------------------------------------------------------------------•------------------------� -----------------------•-------------------------------------------------- ------------------------------------------------------------------------------------------ ------------ ---------------- ------ -------- ------------------------------------ -----------------------------------------------------------------•-----------------------•----------------------------------------------------------------------------------------------- - - ------------------------- -------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ : I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and ules and r gulations of the San Joaquin Local Health District. Si ned- ------ --- ----- -- - A �wner /orContractorl( 9 } ---- - - BY� '@iW \ (Plot plan, showing size of Lot, location sys+em in relation to wells, buildings, etc., can be placed on reverse side). _ FOR DEPARTMENT USE ONLY L I `" U APPLICATION ACCEPTED BY------� -��/4xwlpl-------- -------------------------------------------- DATE-----_$�,V4.1---------------------------- REVIEWEDBY---------------------------------- ------------------------------ ------------- ----------------------------- DATE------ r----- I-----------------•----------------------- BUILDINGPERMIT ISSUED---------------------------- --- ------------------------------------------------ - ---------------- DATE------------------------------ ----------------=------------- Alterations and/or recommendations:------------------------- f� /d �•------------------------------------------•------------------------•-----------"------_- ---------- -----------------------------------------•--------------------- --------------------- -------------- J� ..... -G - ------------------------- -----------------•------ ---------------------------- - -----•----------- ---------- --- I ------ ------------------- --------------------- ----------------------------•-------•------- I ' -- - ---------------- ---------------- -- --- ----- -------------- - - FINAL INSPECTION BY: - f Date-- ------� 7f� - ------ --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California +E F.PZ0.