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1-UR UFFICE USE:/ - ----- ----- � ->_/---__1/ APPLICATION FOR SANITATION PERMIT Permit No. _ .............. �4_/ ... ----------------------------------- ----- --------------- (Complete in Duplicate) �`---------- - " ?"" This permit-Ex fres 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. This application is made in compliancewith County Ordinance o. 549. JOB ADDRESS AM LOCATION_..-- f - - ---E------ - �----�-- -� 7 � P ho yne- H �Q -__,-e---- 7_Owner's Name Address -2---------•-- -<- iPhone ✓ ----------------------- Contractor's -------------------contractor's Name_ 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 ❑ Depth to.Water Tabl,60 ft.A Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ .Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: 11f yes,date--------- -----) No ❑ New Construction: Yes ❑ No HA/VA: Yes ❑ No ❑ F INSTALLATION AND SPECIFICATIONS: , (No septic tank orcesspoolpermitted if public sewer is available within 200 feet.) Distance from nearest well---------------- Distance from foundation__:_:---._.-.-:---..Material-----------------.-----_-----.._--- No. of compartments-------------------------Size..........=---------------------Liquid deol--------------- ---------Capacity Id: Distance from nearest well_.j`�•s41t•0.�4.:?Jistance from foundation___ ...- r ,�--._...Distance to nearest lot line--- Number of lines.--I---_1_. --.--.�- -�_- 'Length of each-lines�__Q-_r- _ Width of trench.-q__ !!-------------- Type of filter material-* `1-`-"-Depth of filter material--- gooff Total length---_- Seepage Pit: Distance to nearest well .�Yl --:Distant rom oundation__ - .-.___.Q'sstance to nearest lot line----------------- ----..Size: Diameter-- Number of pits------ --------- - - Lining material__-_ !J.-- ,� p �___---__--_ Cesspoo Distance from nearest well-----------------Distance from oundation---__.__------_..-. Lining material--------------- ❑ Size: Diameter------------------------ 1 -- -----:Depth-- = -----Liquid Capacity- ------------------=- ----gals. Privy Distance from.nearest well-------------------------------- ----------_.-Distance from .nearest building-------..------__-_.._- ❑ Distance'to nearest-;lot line.---- -------- --------- ------------_..----------•-•--------•------------ Remodeling and/or repairing (describe)-------------------- - a. ------------------- -------------------------------------- ---------- - ------------ '---•- ---- ------- • ----------- --------------------------------------------------- -- ----- ---- ll�t��i*-�► - • - - --- -----•----------------------------------- I hereby cer ' that I have pre d thin applic do and that the work will be d e in accordance with San Joaquin County ordinances, Sta ruI and re ule ions of the San aquin LocZalth District. Si ned{ 9 ) - 1l OZ.-S--•--------------------- - ' - -t-- ---y----- ---------- �I�rr Contract or) , By:.-. ------- ------------------------------------------------------ -------- yCY --------------(Title)-------------------------------------- I (Plot plan, showing size of lot, location of system in rela ' to IIs, buildin , etc., can be placed on reverse side). FORZ&EPARTMENTILISE ONLY / APPLICATION ACCEPTED BY--- -- --- ------ ---- ------------- ------- ----------- ------------------_---------- DATE-------- 1 1 REVIEWEDBY------------------------------------------------ --- --------------------------- •--------------------_- DATE----------- BUILDING PERMIT ISSUED--------------=-------- -------------..------------- •- -- - DATE. Alterations and/or recommendations:--- �4f__._ 1k ------- c -_ 1-c ---••:•• _-- ---_S-_-.C ______________ --- -------------------------- ------------------------- -----------------•--------------------- - --------------- --------------------- --------------- -----•- -----------••-----------------------------------------•-.------ ------------- FINAL` INSPECTION B � {' c 1 .< .. _Date = -- j SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E9.9 REVISED a-69 F.P.DD.yM 6.60 a