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FOR OFFICE USE: -------------------------- - /�� - APPLICATION FOR SANITATION PERMIT Permit No. ........................ k - (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. 544. : u� .. . JOB ADDRESS AND CATION� ------------` - ---- - ' Owner's Name.- Pho e-- -- := - -- = ----------------------------------------- Address-----------,�Cr( - 5---3ffJ---------- L _ .. ° f lfi-s^-"'�U one------- -- -- ----•--•----- Contractor's Name = Ph installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/... Number of bedrooms:_Number of-baths .`�--- Lot size : .9 ----=f- - Water Supply: Public system ❑ Community system ❑ Private �Kpth to Water Tablee_-__.- ft. , Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loam El Clay Loam E] ay obe❑ Hardpan El Previous Application Made: (I#yes,date__................. No ❑ New Construction: Yes;❑ No°❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: P 1permitted'if public sewer-is available within 200 feet.) ' s Septic Nokse tic taDkstancesfrom .nearestDistance from foundation.-__-f,V_.`..__Material_..... --------------------------- s ° t ZQa. • No. of compartments Size` `. _- '.XS! quid depth ------------ Capacity-4- DisField: Distance from nearest well-..s ��----Distance4from foundation._..-. -Q---....Distance to nearest lot line- ----------- posE Number of lines------ I------------------Length of each line----:;---1"�' -�- Width of trench-,-= -_`_---------r----------- I of filter materia!_.-..._s-t _c...--Depth of filter material__.-�.�_rt..____.-Total length_.--/.----------------------------------- Type _ i '� Seep e Pit: Distance to nearest well__' f$a_... Distance from foundation..�(D__._.:---....Distance to nearest lot line..; -`--------- � Number of pits-. -----f----------Lining material-_4115-4Z.,.------Size: Diameter_n, _3-s�-----Dept h-.�f------------------------ Cesspool: Distance from nearest well- _.-____..Distance:from'foundation._.__------._..--.Lining material...________.-- ------------ 0� f. El 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):I --------------------------------------------------- ----------------------------------------------------- I ------------------------------------------ `------------------------------------------------- -------------------------------------------------------------i----- --- - - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules .and regulations of the San Joaquin Local Health District. i ---------Y,(l�wf�ec and/or Contractor) (Signed)_ By:-------- -------------- - (Title)--------- (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). ( F0,R DEPARTMENT USE ONLY �p DATE----CIAO-17 - --------------------- APPLICATION ACCEPTED BY --- --- REVIEWED BY------------------------------------------ ---- .. DATE----------------------------------------------------------- ------------------------------------------------------------------------ BUILDING PERMIT ISSUED------------r------------------------ ------- DATE------------------ --------------- -------------------------- - ------------------- ' ----------- ---------------- Al-t--e--r-a--t-i-o--n--s-- and/or recommendations---------------------------------------------- ------------•--------------•------------------•-------- [ - ----------•----------------------------------•---------------------•------ -- ------------ ----- / PENAL INSPECTION 13Y F ----- - Date---- ` -• -------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 16o1 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 41h Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CU.'