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USE w _PC6/'E____.___1G......... '-_ APPLICATION FOR SANITATION PERMIT Permit No. .1'ky....Q ---------- --- -- --------------------------------------- (Complete in Duplicate) S 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. 549. JOB ADDRESS AND LO0-1-PA I N- Q =/V L/ /._ I/El e �` Owner's Name_ ... -------------------------------------------------------- ------- ----- --..._ Phone__I7/-Z_`, Address........ .......... t-e--�--j� ------ --------------- -�----------- -----------------------------------------------------------------------•----------------------- Contractor's Nam ---O[J �j 'f�j �-.. s� `C,------------------------------------------ Phone..- Installation will serve: Residence �partment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I------ Number of bedrooms ______._ Number of baths! Cot size _,_,_, �' �9__P_ - -------------- Water Supply: Public system E] Community system ❑ Private Depth to Water Table J�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam E) Clay ❑ Adobe Hardpan El Previous Application Made: (If yes,date--------------------) No ❑ New 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.) S from nearest well--------- Distance from foundation___________ ____.Material___-.___________-_-..--__.-_________-____.___-__- No. of compartments- ------------------------Size--------------------------------Liquid deppt,�h� ---- ----- ---------Capacity------------------- 16b Id: Distance from nearest well._&.Q_._._Distance from foundation_____�__a ----.Distance to nearest�lot line___ _ Number of lines___.____- _____________ ____Length of each line----AI-, __............Width of trench----- -4174e _-__!. �i; itme Type of filter materiai_� -Depth of filter material-___-_1 _____ Total length-------------_--------�"-�----- Se ance to near t well_1_0- Distance from f undation___:%0S-- __.Distance to nearest to i'n- ber of pits__ _________________Lining material____ ---------__.5ize: Diameter____ .___Depth____/ ______.-__._._____ Cesspool: Distance from nearest well-----------------Distance from foundation....___.___-______.LininOfferial--- __------------------------------ � ❑ Size: Diameter--------------------------------------Depth------------------------------ ---------------------Liquid Capacity----------------------------gals, 10 Privy: Distance from nearest,weI-------------------------------------------------Distance from nearest building--------------------------- - F1Distarce to nearest lot line--------------------------------- ---------- - -------------------------------------------------------------------------------- ------------ Remodeling and/or repairing (describe):------------------- ---- -- --------- ------------------ ----------.------------------------ ------------------••--------------------------------------------------------------------- ! :tr -------------------------------------------------------------------------------- -- ---- - ---------------------------------------------- ------- ---- --------------------------------------------- I hereby certify that I have prepared this application and that e w rk will be don in accordance with San Joaquin County ordinances, St I w nd rules a 'regulat; -of t e aq in Lo al Health Dist ict. (Signed �L ---- --- --- . ---- Contractor) / By:------------------- •------------------------------------------------------------------- - -- --- ---------------- --- (Title)------------------------ -.-. - - ------ --- (Plot plan, showing size of lot, location of system in relation to ells, buildings, , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ -- ..... -•------------------------------ ---------------------------------------- DATE__.,5_��-- ( ....._Cc ' REVIEWEDBY---------------------------------- -------------- -------------------------------------------------------- --------- DATE---•------------------------------ BUILDING PERMIT ISSUED---------------- ---- - / -------- ----- DATE----------------------------------- IT ----- ------------------------- Alterat'ons and/or recommendations:__ jq�' t •_____�[ _______ __. WV ltl�c-j--------- - "- ---------------- --------- ------------7..� _..gra- -�� .`_�.�. -�9---- -------------------- - - ---------------------------------------------- ------ -------------------------- ---------------------------------------------- - --- - -----... ..-- ----------------------------------------------------------------------------------------- - -- ------- --------------------- FINAL INSPECTION BY:_____ t._ _ Date... --------a_. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.0 O.