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m.)K Vrrlt,t UJt: ....._.`. .........7.':-T. APPLICATION FOR SANITATION PERMIT Permit No. .. ---- --I................................................... (Complete in Duplicate) _ -- .-. This Permit Expires 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 compliance with County Ordinance 549. JOB ADDRESS AND OCATION. „ . ...- •:•,., Owner's Name_ �................... --•--------------- -------•-----------------•••--•-...._..-•--- Phone.................................... Address....... ..----AContractor's Name. - ..4- -- 414t ................. Phone..._._.. •--- -------•. Installation will serve: Residence Apartment House [3 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --f-- Number of bedrooms S. Number of baths ;F-7.. Lot size ......... .....- Water Supply: Public system E] Community system ❑ Private � _epth to Water Table tfl� ff Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe�Herdpan ❑ Previous Application Made: (If yes,date....................) No -New Construction: Yes ❑ No ®-�FHA/VA: Yes ❑ No g�— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se is Tani. Distance from nearest well.................Distance from foundation....................Material................................ ____.___.__..__.. No. of compartments__.-.__.... ............Size_.___..__.......................Liquid de th...........--_--_.._-.._..Capacity x4A, FDistance from nearest well................Distance from foundation....................Distance to nearest lot line........... Number of lines.......... -----------------•-- -Length of each line.. ......................Width of trench------ - ........... Type of filter material---------___---------Depth of filter material.......................Total length..........................._._........... �. Seepage Pit: Distance to nearest well_. � .�___Distance frgm fo ndation.. �p. ..., istara to nearest of lin�1�4�_._.E O Number of pits..................Lining materia l___ _ _c 6_..Size: Diameter___.........Depth .�'. ................. � ..Cesspool: Distance from nearest well.................Distance from foundation____.--.-.-...-..Lining material................................ ❑ Size: Diameter._._..................................Depth-.--------------• --._-_---------..__--.--.-._Liquid Capacity_...................__-gale. t'rivy: Distance from nearest well........................ ........................Distance from nearest building........................___................ ❑ Distance to nearest lot line..............................--- ----• ------•--•-......_•- Remodeling and/or repairing (describe):....... ------------� u ..:r.............. ...........------------------------••-•----•----• 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 a d regulations of the San Joaquin Local Health District. 6 / ................•--1 :1rer Contractor) (Signed).....................•--•---- .• - ...�'...._. ��-��(f.-..............._..- - - ---- - --.............. By:.....................•--•----•-•............• (Title).. -------•-•- ------ - • .rz ----- ---- --------------- (Piot plan, showing size of lot, location of system in rela r o o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..........4,"t.................. --------------------------- _........ DATE-- �-1 f..`�------------ REVIEWEDBY----------------------------•------------•--- . -------------------------.-------......................................... DATE............----------------• -.. BUILDING PERMIT ISSUED.............•------------ DATE....... ..................... Alterations and/or recommendations:._,_.__ �,1. ./...t`�f.••....._....-, � - —(-___I.- ,[ .......................... � ......................................................... .......................... ....................•-•.................................................. •-- ..........................................-...................-..............................--........................................ ......I..............................................................................-..............................•..-•-•--•....---•--................I..........--•••----••••. ......_•-----...........-.........---- ................................•--•--...... ----•.........................•.... ........-........_-............_............................... ....... ................................... t FINAL INSPECTION BY:._.44:1.......--...�` / � - -.. ...-•-------------------- Date----- ••-•-----•------• -.........------...'............--------.... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 f.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.00.