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FOR OFFICE USE: r , --------------------------------------------------------- -0111 _'� 4 /// (o APPLICATION FOR SANITATION PERMIT Permit No. .Q :f_..... ----------- -- ---------------------------- ------------ {Complete in Duplicate) ----------------------- -----------------------_- -- This Permit Expires 1 Year From Date Issued bate 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. 549. JOB ADDRESS AND LOCATIO - �__----1-�---.-( _ � --" f' ��---- Owner's Name---- - ,/ Phone 1 J --------------------------------------------------- Address------------------ --------�Z---------- //__ 0 ��f --- ------- - Contractor's Name--------- _-'-- `-------- --------- rJ -�`J. � Phone- -Installation will serve: Residence 3---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___f Number of bedrooms __3_ Number of baths ---.T'Lot size ___ --_______________________ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table -Y-' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ®- lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date________ __-----__ 1 No [ New Construction: Yes ❑ No [SHA/VA: Yes r / o ❑ 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-----------------Distance from foundation--------------------Material---------------------- ------_----------- ______- ❑ No. of compartments----------_-------------Size--------------------------------Liquid depth------------------------._Capacity---------------------- Disposal FiId: Distance from nearest weEl__-��d�.-Distance from foundation-_/0 - .____ Distance to nearest lot Number of lines------JU -----------Length of each kne_A "C 7____.Width of trench___ "-_----- -_ �1 Type of filter material_, / r __Depth of filter materia!'-_/P"_...__._Total length-----/ __°!_-________.____ r f�'1 ' Seepage Pit: Distance to nearest well----------------------Distance from yidation--------------------Distance to nearest lot line__.____-_________ 0. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---r.--------- --------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation... ................Lining material____..._----____.___.__.____________- ❑ Size: Diameter- - -------De th----------------.t--------_------------------__t_Li uid Capacity ---------- ---------gals. Privy: Distance from nearest ll from nearest building -_ {'-------------------------- ❑ Distance to nearest lot line_ .w 1�- , Remodeling and/ airing (describe):------.-- � -- --- -_----- -_-.--- • ---------------------------- ------- ---- ------ - ----------------------------------------------------------------------- -----------------------------------------------------••------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this plication and that the wor ill be done in accordance with San Joaquin County ordinances, State laws, and rules and reg to of the San-J aquin Loc ealth Dist (Signed)----------- *-- �'------------------ -•-------- . O era d/or Contractor) :. � fi. - =- Title F By:------------ -�--- . (rifle) -- -... -- ---- --------- - ------ Y (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATIONACCEPTED BY------ 1_ ....... - ---------------------- ---------------------------------------- DATE----------- / �7------------------------ REVIEWEDBY--------------------------------------------------------------- ------------- ----- ---------------------------------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------r--------------------------------------------------- DATE---------------------------------------------------------- Alterations and/or recommendations:.____--__.�a_------}3RfAC --- --------cL'_o�__..__. ------- ____Ahl=/L., N ------------------------------------------- -- -•- ---;:- ------ - ----- -- ----- -- ----- - ---------------------------------------------------------- a FINAL (NSP N - --------- Date----------- ------- --------` ------------ ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.