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APPLICATION FOR SANITATION PERMIT Permit No.nJ � _- __-• -_ (Complete in°15u`•plicatej } Date Issued -----____-�--_-- Application is hereby made to the San Joaquin Local Health Distric f apermit to construct This applica#ion is made in compliance with County Ordinance No549. and install the work herein described, JOB ADDRESS AND LOCATION___-�-_®3 ------ ---------- - ----- -- �� _ Owner's Namo_-----�"- �. - Address__ 1 - -- ---------= Phone------------------------ - -- - 4. r ---------------•-------------------------------------•------•------- ----- Contractor's Name---- _-- --_-f��-_-- - ---------•-__---- - . - ------ -------------- - Phone---------- ------------•---------- Installation will serve: Residence � ----- - Apartment Housei[ yommercidl ❑ Trailer Court t ❑ Motel ❑ Other ❑ Number of living units: __�_-__- Number of bedr oNumbe�of,.ba,ths��o-A Lot size ----- -_x �� Wafer Supply: Public system Community stem --_------ Y .y ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam L-] Clay [IAdobe Hardpan ❑ Previous Application Made: Yes E] No V,, I j ❑ ❑ew Construction: Yes No FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I III � (No septic tank or'cesspool permitted if publicKsewer=is-ay.ailable.-wrthin-2oo fe-W e tic Tan Distance from nearest well___ ____________Distance from foundation-_.---____ ----------------- ---------------- �. Size ----------------Liquid depth--- Capacity o. of compartments:.-_- _� Drs osal Field: Distance from nearest we' ---------_-- . p '!1__ Distance from foundation._-. 0.....-_- �� _� Number of lines Distance ___ �--- Distance to nearest lot line !--4�---_-_- th of each line----- T e ` g it� ---r Width of trench- ' "' ---- Type of filter mafierral 5 S- I'_ e th of filter material--------- -----------Total length-------- b --------- Seepage Pit: Distance to nearest well._i --__ _ ❑ dumber of pits.- mDteraalf#� "Size � Distance #o nearest loft line_---------------- p arae,#er------------------ \1 Cesspool: MA Depth stance from nearest well----- _ _Drsta,_5'torn foouiidd on__ _ _-_ _-_.Lining material------------------------------------- Privy- ------ ❑ Size: Diameter----- --- ------ -- _Depth __-- - - -- -- ------ --- -------Liquid Capacity -------- gals. �vY� Distance from nearest well 11'"'14_4*.w` --------------------------._.__Distance from nearest buildin p g -------------- ---------------- --------------------------- --------------- Distance o nearest lot lin� / - ---------------------- ----------------- ------ -------- - �Remodeling an�f/or repairing (dessr�i }e ------------- -- ----------- --------------- -- --- --- --- ---- --- --- --- ------ -----------------------------•--- I hereby certifythat ! have re a ed t is application and that the work will be done in accordance with San Joaquin County —.�..__ •------------------- -- ordinances, State las, and rules and regulations of the San Joaquin Local Health District, (Signed)______________ • (Owner and/or Contractor) BY:---------------------------------- --- { p --------------- t (Title)------- - ---------------------------------------------------- ey at an, showing size of lot, location system in relat,on-tolC4''ells,�builitings�� tc��can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---_--_.-_ __--_.____ , ------- ---- ------------------ ---------------- DATE----- aREVIEWED BY---- -- -- --------------- - --------------------------------------------- -BUILDING PERMIT ISSUED______________ DATE-_ -- - -- ------------- ------ ---� - • ------------------------------------- DATE -- and/or recommendations"` ----�_..,_ -----------_------ -------- --------- ----------------- ------- ------- -- ------------------ -------- '--------•----------- ------------------ ------- ----- ------ ------ ------------------------ ------------------------------•- ------------------------- ------------------- rF1NAL INSPECTION BY-------------- ------..s--------------------------------- - — LPV-- � li Date-- -------------- - -- - -------------------------------- SAN --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT `C� 13D Soufifi�Amerioan S+reat ' tt 300 Wesf Oek'Stree+"" � �� ' '- `�--� t� ` J132`Sycamore Street �' 814 Nor+h "C" Street Stockton, Cali' Lodi, California `'" Manteca, California Tracy, California 4 5 4-2i�1 Rev.isea 1-57 F,P.CO.