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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- ------- ---------------- --------- ----------------- (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. JOB ADDRESS AND ,LOCATION-------- _ 1 ��t c' -------------------------------------------------- - ----- Phone--------------------- Owner s Name-----/ ---•--��--�� . ---•--._�-�'-'�__��--_�= —:___.��..----- --...------ ---- - ts` .�� f-��/fes _ - ---------------------------------------------- •---... Address.- •----••---------_-�------------------•_----•-------- ..__. r � # _ �#' f ----------- . a a Q(� Contractor'' Name-----,--•-•---- � - ---- ._ . ..��Y!?__ c __ /n��..---------- ----------------------- -----------Phone--�`•-�-'--`f-----l-.,1--.. Installation will serve: Residence 4 Apartment House ❑ Commercial. ❑ Trailer Court ❑ : Motel ❑ Other ❑ Number of living units: _ Number of bed'OT k3I Number '0AI hs _ -- Lot size __.__/_ 4. _ ------------------------•- Water Supply: Public system Community system`a]i Priv et❑ epth to Water Table :____-._ f#. Character of soil to a depth of�3 feet: Sand E] Gravel'] Sandy Loam ❑ Clay Loam p Clay E] Adobe 5Z[ Hardpan ❑ Previous Application Made: (if+yes,date----------------- - ) No ❑R New nstruction: Yes E] No El FHA/VA: Yes ❑ No [ITYPE OF INSTALLATION AND SPECIFICATIONS; Nose tic tank!or cess oo1 permitted if ublic•sewer-is-available withi 20o feet.) ( P � P! P P � Septic Tank: Distance from nearest well___---------------Distance from foundation2_----_____.MateriaL__.___��ti �_----------------------- -------------------- ________--___._.___-_- ! Size - -------------------)-----Li Liquid de th ------------�� Ca'aut ❑ fSf No. of compartments---- --------------- - q P. P Y Disposal Field: Distance from nearest well---___'- +w`Distanee+from.foundationlv '°Distance toviea�est3lot,line_` ^{ Number of lines------------ Length of each line_________ of trer h___- >� Type of filter material----- k7–Depth of filter material--- --7 � Notal{1.e`ngth_ ._t__:. __________________ Seepage Pit: Distanceto nearest well-------------- Distane'fro foundation____ /_-___.Distance to nearest lot line-__/_ _-.. tiK Number ofpits---------/--------Lining material----- _� Size: :'Difameter-------3..�----_--Depth_.__-.-__��-------------•I J Cesspool: Distance from nearest well--------- ------Distance from f undation .--.---.--------.Lining Material.....................------______-___. ❑ Size: Diameter- --- ----- --------- ------- ------Depth---------- ) Liquid Capacity----------- ----------------gals. Privy: Distance from nearest well_______-_:,- j---... �+tt __--------- __Distance from nearest--building_-_______- _.._._.-____. Distance to nearest lot line-- --- --- ---------------------------- -----L--- ] --- ----------- --------111P------------ -• ----------------- t ; �j� / Remodeling and/or repairing (describer ----- L00- --- � . '/_. 1`1 ~ ._ ------------- ------------------ --------- --•- ----- i 1 ----- ------------------- r_ - _`! % ---------- ---------}` - ------- {; ---------- --- 4 I hereby certify that I have prepared this application and that the work will be done-in accordance with San Joaquin County ordinances, State lawn' and rules and regulations of the an Joaquin Local Healfih District. j IF r ��'✓-�- • (Owner and/or Contrattor 1 --J---- ---- (Signed)----=------ -----------� --- - ca on of s stem m r By_________________ ___i._ (Title) --- ________.-. __- a ------- [Plot pian, showing size of lot, 1 .,,yelation t� o,�w,.ells,,.buildings„�et;.,kcan be placed on reverse side). FOR DEPARTMENT USE ONLY APPLIC TION ACCETE©BY_. ::.. DATE �---------------------- REVIEWEDBY-------------------------------- -------- - - ------------------------------------------------------------------------------ DATE---------------- ------------------------ ------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------ ----- DATE------------------------------------------------------------ Alterations and/or recommendations--------------- --------------- ----------------------------------------------------------------------------------------------•----------------- *.— ------------- -------- ---------- ... ------------------------------------------------------------------------------- ---------------------------------------------------------------------•----------------- --------------------- - - -------•------------------------------------ ---------•--------------------- ---------------------------------------------------- -------------------------------- ------------ ---------------------------------- - - ---------•-- ----- ` FINAL INSPECTION BY:.------- A%'- Date----- � i/ ��---------------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Masoltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.r U.