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- -- ----------- ----- -------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------ ----------- -------------------------- (Complete in Duplicate) --"-""" --------- --------- ------------ --------- --- This Permit Ex ires 1 Year From Date Issued Date Issued _-- Application is hereby made to the San Joaquin Local Health District for apermit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. f JOB ADDRESSD LOCATION--- #+ -_ r W-COwner's N e..- _.. r -------------�Add ---- -- - ----------- Phone ress.. ¢�:•;e�. _•- _.------ � ° -----•---------------- ---------�,/ �/ yy� /� ------------ Contractor's - ---Contractor's Name. `-• 4�- -------w --------- -- •-- - -- _-- Phone-- Installation will serve: Residence partment OuseCommercial F1 Trailer Court ❑ Motel ❑ Other E]Number of living units: A---- Number of bedrooms� Number of aths --_.L Lot size .._ ------------- Water Supply: Public system El Community system ❑ Private Depth to Water Table 14A. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay [] Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ElNew Construction: Yes No ❑ FHA/VA: Yes ❑ 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--6_a"---"Distance fro fou on--- p-----_,Ma --- " ' No. of compartments jtrweV f r p --- ---------- Size iciurd depth ---------Capacity-- --`-� f If Dis osal Field: Distance from nearest well/" _----- .-Distance from foundation.._/� /' .-..(..Distance to nearest lot line....____ Number of lines--...1-- __-. ----Length of each line-----9 -------Width of trench.- -- .0e la of filter materia Depth of filter material..f_�"/__-._Total length_--__-- - ""�"".----- --- aa} Disfance to nearest well----- _______ ____Distance from foundation........-.-.-_._--. 9 - Distance to nearest lot line_.....__.._.- -_ Number of pits- ------Lining material----- - - ----------- Size: Diameter----------------------Depth-.---------_,----"-------- ----- 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 ----------- -----Drstance to nearest lot line_.__.___.."-__...."__ _ �., ------------- Remodeling and/or repairing fdescribe)----------------------------------- --- ------------------------------------------------------- . ------------------------------------------- --------------------------------------- ------------------------------------------•------------•--------------------- ------------- -----------------------------------------•----- -------------- ------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta s, an d regulations of the San Joaquin Local h District. (Signed) 7.. ` -4 - 1 !_ - ------ -- --------- --------------------- Contractor) By:--------------------------- - - --------------- - ------------------ -- -- ------------------- - Pot plan, showing size of lot, location of system in relation to well uildings, etc., can placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....__.._._.-..'.fit- - -=------------------ --- ------------- DAATTEE------------------------------- D --.--r----------y-- -- - ----------IEWED BYTE-- l ------------------------------- - ------------------------------ ----------------------------------------- --------------------- ---�-- -�---- ------------------- _ DA - ------ BUILDING ISSUED Alterations and/or recommendations:._.-.-_-.."_."._..." - ---------------------------- ------------------------------- -------------------- --------------------------------- - ---------- ,FINAL INSPECTION BY:... - ------ - --------- ---- ------- - Date.. /( �114 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California` F.1A.0 C.