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F R.C�FFICE USS: ------ --------------------------- - APPLICATIO14 It SANITATION PERMIT Permit No. (Complete in Duplicate) ? q 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 and install the work herein described. This application is made in compliance with County Ordinance N 49. �t c J08ADDRESS A D LOCATION'.... --------------------------------------------- ---- ----------------------------------------------------------------------- Owner's Name - - - --------- ------------------------------------------- ---- - ---------------------------- Phone--- ��---- - --------•------ ----------------- ------------ _g , Address Contractor's Name s --------------- Phone_ [ �. _ � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units:",`__ Number of bedrooms _r _ Number of baths __/__ Lot size ___� --------------------------- Water"Supplyc`Publieystem'❑- Community system ❑ Private X Depth to Water Table ; �ft. Character of soil to a ddfl`of-3"feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application�Ibde:�(Ifyes,date_.- -------------) No [P�New Construction: Yes El �HA/VA: Yes El E]. _ �., 41 TYPE OF INSTALLATION AND.-SPECIFICATIONS- (No ND.SPECIFICATIONS(No septic tank or:cesspool permi+ted if public sewer is available within 200 feet.) pATank: i Distance from'nearest well-----------------Distance from foundation__------------------Material------------------.------------------------------ I No. of compartments--------------- -'-"-----Size---------------_----------.-__.-Liquid de th------------------ Ca acit D sal ield: Distance from nearest well-----I-----------Distance from foundation____________________Distance to nearest lot line----------------- , Number of lines----------------------------------Length of each line----------------------------.Width of trench--------------.--------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance fo nearest wellZ_— _7 __ ._.___ ._ Distance m fo ndation_ I0.__.__.Dista�nce to nearest lot line____ V" �r [� Number of pits____-_---------Lining rn terial___ Size: Diameter..�_�______________Depth_...-_ _Q__�___...___.__ O s '.;Cesspool: Distace from nearest well_________________Distance from foundation....__--.---------..Lining material__._.___________.._._-. -_----__-..._ 0 ate ❑ Size:Diameter-----------------=--------------- ----Depth--------------------•-------------------------------Liquid Capacity----------- gals. � _ r Privy: Distance from nearest well-------------------__________.------------------ Distance from nearest building------------------------------------------ i ❑ Disfance to nearest.lot Iire----------------- ----------- ----------------•------------------------•------------------------------------------------------ ---------- f and/or repairing (describe):------------------------------------- ---------------•---•--------------------.------------------------------------------------------------------------- -------------------------------------------------- ----- -- --- f ----------------------------------------- t-----------------------------------= --------------=------------------------------------------------------==----- --------------------------------------------------- -------- I hereby certify that I�have prepared this application and that the work will be done in accordance with San Joaquin County ordinances "S eklavis,;and:;�rules and r gulations of the San Joaquin Local Health District. `►.(Signed)---- ------ -- -- ---- ------ -A-------------------------------------(Owner and/or Contractor) By:--------------------------------------------- -- - - ----- --- -------- -------- -- -- ------------------(Title) C --------- (Plot plan, showing'size of lot,'loca+ion of system in relation to weJl�, buildings, etc., can be placed o reverse side). f � r FOR DEPARTMENT USE ONLY APPLICATION f CCEPTED BY -------- f DATE REVIEWEDBY- '--------------------- --------- ----------- ---------------- - -------------------------------------------- DATE---------------------------------------------- -------------- BUILD]NG,PERM IT ------------- BUILDING=PERMIT ISSUED---i `---------------------------------------------------------------------------------i--------- DA•TE----------------------------- ------------------------------- Alterationsyanfd/or reem en atlans: 7 / _.- - r fo�.... _/--------- ------= = _ -Cam-k',[!_.. ./��° •.t':-i' 4_! ---------------------------------------------------- `r :r� -------------- ----------------------------- --------------------------- -- --------- - ---------- ---- ------------ -- ---------- •- ----------------------------------------------------------- ------ --- FINAL INSPECTION BY:.---- ---------------------------- - ----------- Data------7./ -19------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California