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FOR OFFICE USE: g APPLICATION FOR SANITATION PERMIT Permit No. .. 1..�P-1 ------- --------- ---------- ----------- -------- -- --------- ------------ --------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued V -f 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. S49. � � gs7n E - f4 g, J08 ADDRESS AND LOCATIONS _- GF fir'` _C� ��' Owner's Name--- � ." ------------------------------------ -- ---- ---------------------------------- ----- ---------- Phone-------------------------------------- Address-------- ---•------------------------------Address---------- c - ------u`-'-rk'-------------••-•--- " Phone---------------- - Contractor's Name--- ----!-------&r`-1 `."' . ------- - --------._ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: r Number of bedrooms x _._ Number of baths _2.,-- Lot size ----------___________________________________--_-____-.--__ Water SupplyE 'Public'system'❑-Community system ❑ PrivateDepth t Water Table _____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam [Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewerjs available within 200 feet.) G compartments----- ------ -X---------Size--------------------------------Liquid depth------------------------- Capacity-;--- (Yl __._ Septic Tank: Distance from nearest well____--__:.._---Distance from foundation--------------------Materia--_.____----_-_.-_. Disposal Field: Dista ce from nearest well-----------------Distance from foundation_-__-_.---------------Distance to nearest lot line----------------- ❑ Number of lines-------------------- - -- --------Length of each line----------------------------- Width of french------------------------------------ 0 Type of filter material-------------------------Depth of filter material-----------------------Total length--------------------------------- .�` @of Distance to nearest well------l_QQ__-___Distance from foundation____/O_____._-_.Distance toynearest lot line---- .__..__.__ ` El Number of pits Lining material -� -Size: _3--x_I D-Depth f *' Cesspool: Distance from nearest well-------------- --Distance from foundation--------------------Lining material__.--__.--_--______________________ Size: Diameter------- ------------------- ----------Depth_.. ----------------------- ------------- ---------Liquid Capacity----------------------------gals. ❑ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-.__.---_ ------------- ------ ❑ Distance to nearest lot line----------------- - ---------------------------- Remodeling and/or repairing (describe):_ ------------- ------------------------ �ry --------------------------- -- -------- --- --- ------- "`J��`{ ---- - ---------- -- -------------------------------------------------•-----------------------------------------------------------------------------------------------------------------I----- 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 d rules and regulations of the San Joaquin Local Health District. (Signed)-= -u-- - _ -------------------------------�P;Merpd/or Contractor) ------------- -c - _ -- ----- ------------ -- ------------------•-- -- (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ��/7 'u ------------------ DATE------ ----- _�A------- ----------------- REVIEWED BY------------------------- -- DATE - ---------- BUILDING PERMIT ISSUED ------------- -------------------- DATE----------------------------------------- ------------------- Alterations and/or recommendations---------------------- ---•--------------------- ---------------------------------- ---------------------------------- ----- ------------------------ -------- ----------- "-- ----- Date.--------- .2-* -------- ------------------------------- FINAL INSPECTION BY:- ------ - ----�-- - --��------------- ------------ - ��--`��------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haielfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lod'+,California Maifeta,California Tracy,California F.P.C O.