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_ FOR OFFICE SE: t --- --- -------------------------- - -. e/y I APPLICATION FOR SANITATION PERMIT Permit No. .............:._._L-----. ---------------- --------------- ------------------------------- (Complete in Duplicate) 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 No. 549. / JOB ADDRESS AND 'ON..... r -- - •--------------------------------•------------------ ---------------------------- LO ATI ��-Com.... -- - ----��"- Owner's Name----G ' - -----d��/. . ------•--------- -------- Phone------------------------------------ Address -•---•...... ---------------,sw ----------------------•------- -••-------------••----•--•--- ------ ------------------------------------------------------------------------------- - Contractor's ---• -----•--•-----------•------------••---------- Contractor's Name `/ Phone --•_- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ] Other ❑ Number of living units: -f---- Number of bedrooms -- Number of baths --C;Z7 Lot size --- �� 1--r�- ------------------------ Water Supply: Public system �ommunity system El Private ❑ Depth to Water Table A�tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2---Hardpan ❑ Previous Application Made: (if yes,date_____ ___________) No P"� New Construction: Yes ❑ No Z?'�_FHA/VA: Yes ❑ No 9;--er TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan ` Distance from nearest well-----------------Distance from foundation-------------------.Material-------_---.-..------_.----------------.------ No. of compartments------------------------Size--------------------------------Liquid depth - Capacity Disposal Fi Idr Distance from nearest well---+��f-Distance from foundationZC�-------..Distance to nearest lot line-�-.---_---- � i ` �/ Number of lines---------l------ -----.. ength of each line----��-�--------- Width of trench.- -`---.-,--/,-------------- �/ Type of filter material--? / _-Depth of filter material___ 1 _.-----__Total length--_,:�---_-.. ` � �-�-:Distance from foundation__ f -Distance to Barest lot Gne .� 5 epage Pit: Distance to nearest well._. .- �� Number of its---- ..- ..Lining material-,eI�__e;e-Size: Diameter--. -,; Depth- Cesspool: Distance from nearest well-----------------Distance from foundation------------------ material------------------------------------- ❑ Size: Diameter--------------------- -------- -------Depth--------------- --------------- ---------------------Liquid Capacity----------------------------gals. a Privy. Distance from nearest well-______-----------------------_.----------------Distance from nearest building----.-____.-------------_-------------_ , ❑ Distance to nearest lot line- ---------------- - -- - --------------------------------------------------------------------------------- - ---------- 5 Remodeling and/or repairing (describe):-------------------- ---L` ----- --- ---- ----- -------•------------------------------------- --------------------------------------------------- p ------------- ------------------------------------------------------------------------•------------------•-•-------------------- ----- --------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules jLjnd regulations of the San Joaquin Local Health District. -- - ---- -- --------- ----------- - ---- -------------- --------- -(Owner and/or Contractor) (Signed)------------ Title--- �� By:----------------------- -------------------------------------------------- ------- - - -------- l ] (Plot plan, showing size of lot; location of system in ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ATE APPLICATION ACCEPTED BY----- ------�?'`�-----_- ------ D -- (-- --=-------------- REVIEWEDBY----- ----------------------------------------- - ----------------------------- DATE BUILDINGPERMIT ISSUED---------------------------------------I--------------------4:�LL�-----------------------r------------- DATE-----------.---------- -------- ------------------------- Alterations and/or recommendations:--------�"+ ! ` I -O -------------------- :Y "-`rte .---- d ��t'�r� i cJ L_� - -- --------------------------------- ---------•------------- ------------------------------------------- --------- -- --- -------------------------- / --- 0 r - � Date.--------- ..1__---- - --- ---=-------------------------------- - FINAL INSPECTION BY:..-._-_ (- -�-�- SAN JOAQUIN LOCAL HEALTH DISTRICT l 1601 E-Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California F.a.c o.