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FOR OFFICE USE: - ------------ --------- ------------------------------------- Permit No. APPLICATION FOR SANITATION PERMIT - =------------------------------ - -- ------- ------------- -- (Complete in Duplicate) Date Issued 11/721':7::/'P-�=��-4 -- This Permit Expires 1 Year From Date Issued Local Application is hereby made to the San Joaquin ------------------- --------- -------------------- l Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANADOa --------------------------- Owner s Name- -, --------L) - - ------------ ---- Phone ------------------------------------------------------------------------------------------------ - Address----------------- -- ---- Contractor's Name--------- - ---- -- - -- Phone ------------- Installation will serve: Residence � Apartment House El . Commercial E] Trailer Court 0 Motel Ll Other 0 Number of living units: --/---- Number of bedrooms -3--- Number f baths --?� Lot size ----14-6-4--e–c-- - --------------------------------- Priva WE -------- ft. Water Supply: Public system F1 Community system El te Depth to Wafer Tabi'a Character of soil to a depth of 3 feet: Sand [] Gravel 171 Sandy Loam [Clay Loam E] Clay 0 Adobe [3 Hardpan 0 Previous Application Made: (if yes,date._--___-_-------- ... ...) No F1 New Construction: Yes El No El FHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation--------------------Material-------------- ------- ------------------------- F1 No. of compartments-- -----------------------Size--------------------------------Liquid depth-------------------------Capacity----------------------- 1 -511 510 * 1 ------ZA---------Distance to nearest lot line----------------- LASD'isposal,Field: Distance from nearest well... ------------Distance from foundation Number of lines--------------(-------------------Length of each line------- ------Width of trench-------- Type of filter mate _!___--____Depth of filter material-------If............Total length---------- earesf lot lfine__-__._________.q Seepage Pit: Distance to nearest well------ ---------------0iistance from foundation--------------------Distance to n ---------- ------ F1 Number of pits----------------- --------Lining material-----------------------Size: Diameter----------- -- --------Depth --------------- Cesspool: Distance from nearest well_________________Distance from foundation----- --------------Lining material-_.____------___._____.__----__.__-. Diameter----- --------------------------------De-P-fih—'------------------------------- - ------------- - Liquid Capacity----------------------------gals. 0 Privy: Distance from nearest well----- --------- - ------ ---------------- -Distance from nearest building -t- ----------------------------------------- 171 Distance to nearest lot line-----f---------- -------------- ------------------------------------------ ------------------------------------------------------ Remodeling and/or repairing (describe):_------------ —1 ------ --------- - ----- ------- ------- --------------------------------------- --- ----- ---------------------------------------------- ----------—-------------I------------------------------------------------------------------------------- ---------------- -------P---- -- ---- �-j ----------------------------------- ---------------------------------- -------------------------------- --------------I--------------------- ----------------•-------•-------•------ ------------ ------------------------------------- ------------------------------------------- -----------------------------------------------------------------I---------------------------------------------------------that'4 ----------- Joaquin Ct I hereby certify that I have prepared this application and he work will be done in accordance with San oun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. and/or Contractor) By:------- ------- (Title]- ----------- --- --------------------------------------- - - ------------------ --------------I-------- ------ - ----- t verse side). (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can be placed on re FOR DEPARTMENT USE ONLY ----------- APPLICATIONACCEPTED BY- -- -- -- --------- - ----------------- ---------------------------------------- DATE--- ---------------------------------------- REVIEWEDBY----------------------------- - ------ DATE----------------------------- --------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------- —--------------------------------- .... DATE----------------------------- ------------------------------— Alterations and/or recommendations:.---------------------------- --------------- -------------------------------------------------------------------------------:------------------------:------ ------- ---------------------- ---------------------- ------------------------ --------- -----——--------------------------------------- ---------------- -------- -------- --------------------------------------------- ------------------------------------------------------ ------------------------—--------------------- -------------------------------- ------------------ ----------------------------------------------------------------- --------- -------------------- ------------- ----------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- -- ------------------------------- -- --------------- ---------------- - ------------------------.—--------------------- -------------------------------------------------- --------------------- ---------------- Date---- --------- ----- ------------------------------------- FINAL INSPECTION BY:.-O:��- ------------------ —---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,calif*rn laLodi,California Manteca,California Tracy,California F.P.C C.