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FOR OFFICE USE: "�- . .."- " APPLICATION FOR SANITATION PERMIT Permit Flo. .__--o� 3----- --- ------ -- --------------------------------- --------- ----------------------- -_---__ (complete in Duplicate) Date Issued Z��-�-=�- ------------pP-------- ------ --------- -- This Permit Expires 1 Year From Date Issue 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 ,COrdinance o. 549. ' :J �J "7 ": -- --------------- JOB ADDRESS D LOCATION,.Q_____________P"---.- d` f-:-- ---------- -- --------- Phone. Owner's Name__ --"--------------------------------- Address_. ----------•------------------------------------------------------------------•-------------------••--------------------- (;f Z� Phone-------_-----•------.----"------- Contractor's Name_ - - --------------------------------- -------------------------------------------- - -------------------- - -- - Installation will serve: Residence ( Apartment House [I Commercial [] Trailer Court ❑ Motel ❑ Other Number of 1.living units: ___t___ umber of bedrooms� Number of baths __!___- Lot size ___9 -- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -draft. Adobe 0—Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ „Sandy Loam ❑ Clay Loa Clay ❑ A VA: Y se ❑ No [ — [,� Previous Application Made: (If yes,daie_,.__.._.-,-...._ -) No ®�hlew Construction: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) r Septi Tank: Distance from nearest well____-___--_____Distance from foundation-------------------Material-___.-.._-_____-____-.___-----------.----------- No. of compartments-------------- -------- Size.--------------------------- -- Liquid depth Capacity , � f ------------ I Disposal Field: Distance from nearest well-,.,_�"'___.. Distance from foundation--& to nearest lot ine__ Length of each line---�p-*---------------Width of trench_..-;_.!K----------------------- material of linas___::f-_._ :-- . .9 ------�--- _'De th-of filter material----��------ --._Total length------- p------- ------ �--� -- Type of filter P. See age Pit: Distance to nearest well------ __.._____Disten�e rom foundation--- Distance to nearest I line_.. __..____-" Size: Diameter 3`� ---Depth-_ ---------------- Number of pits------.-------------Lining material____,./_-".----=- ---- Cess ool: Distance from,nearest well__---"-_-_.._-__.Distance from foundation.__--._.-__-------.Lining material__________ ______________________ p --------_Li uid Capacify ---------•gals. ❑ Size: Diameter----- --- - -------------- --------Depth --------- -----°-- -- ------ ------- - q P Y----- ------- -- ( _----" --Distance from nearest building --------------------------------------- Privy: Distance from nearest well-____-_ _ __- __.-- Distance to nearest lot line------------------------- - ----- - -----------•----------------------- I -t----------------------- i Remodeling and/or repairing (describe)---------------------------------- -----E-----"-------------------------------------------------------------------------- -------- ---------------------------------------- ---- I ' :Y ------------------------------- -- -------------------- ------ ------------------------------------------------------- ----------------------- ----------------------------------------------------------------------------------------------------------------------------------- ( will be done in accordance with San Joaquin County I hereby certify that I have prepared this application and that the work ordinances, State law ; and rules and regulatitons of the San J aquin Local Health District. f r Contractor Si ned _ _ ' ---------------------- ------ -----------------(ocaner an d/o 1 ttl - -------------- --- - - -- r ( T e f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE NLY s ----- DATE ---- ------ - -------------- APPLICATION ACCEPTED BY ATE------------------ ---------- '. DATE ------- ---- REVIEWEDBY---------------------------------•-... -------------------------------. _ DATE BUILDING PERMIT ISSUED-------------------------------- --- --- e ------- -------------- a ffc Alterations and/or recommendations:------ -""- -- ----- ---------"---- ----- ------------------- --- '. ------------------------ ------- ---- ------- - ------------ t - - - ----•---------------------------- ----------------- --------- ------------ ------- --------------------- --------- i --- - Date__. f � -------- --------------------- ------ FINAL INSPECTION BY: . - _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 30o West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California c.v.ca.