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APPLICATION FOR SANITATION PERMIT Permit No..- r. t_.4 (Complete in Duplicate) a /Date issued Application is hereby made to the San Joaquin Local Health District for a permit to(� ct(nd ins all the work herein described. This application is made in compliance w' ounty Ordinance No. 549. JOB ADDRESS AND LOCATION----- -- ----------- ---------------- ------ -- ----- - - - ------ -------------- �-----r------------------- - ---- s------- - Owner's Name -------V------!'-✓=" -------------------------------------- Phone ------------------------------------- Address ---------- ---•--------- ----------------•-Address----------3 diGr - ------- -t ---------------------------- ------------------------------------------------------------ Contractor s Name------------- �------------ -- --------i---�-----C--- - - --4-------- -------------•--- Phone------------ ----------•-•--------- Installation will serve: Residence ❑ Apartme House ❑ Commercial- Trailer Court C] Motel E] Other [;] Number of living units::____.__ Number of bedrooms -------- Number offf b�`ths ____ Lot size____________________________________________________________ Water Supply: Public systemCommunity system ElPrivate E] Depth to Water Table --------- ft. Character of soil to a depthAfeet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan C]Previous Application Made: Yes E]No VNew Construction: Yes E]No 9 FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sis Tan : ..,I( Distance from nearest well____________ Distance from foundation________________ Material ------------------------------------------------- VNo_ of compartments -------------------------- Size -------------------------------_Liquid depth -----•-------------------- Capacity ---------------• - j 11 Di oral F 4qa Distance from nearest well____._.__ _-'-Distanceofom eachI ne atiionn_�---------------Distance hto nearest ea es t line -----------__--_-!i v Number of lines________ -- ____ Leg i "� T pe of filtor material_________ -Depth of filter material___OV�- Total length__ �?_�'_� _•_..,__ ____ e Pit. Distance to nearest well --�-___Distance m foundation__ ______-.Disi to nearest lot lines f_____________ Number of pits ______------------ Lining material___ r _Size- Diameter___-________ Depth___.- .----________- W s ool: Distance from nearest well_________________Distance from foundation _-__________.____.Lining materia!_______._..,_________. ---------------- ,O i ❑ 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):} �%`E 3 -------------------- ---------------- ----------------------------- --- -- ---------- -_---: -_- ----- ----------------------------------- -------------------------------_______------- --a ----- ____ _____ __ ______.___--______---.----_______________________________-______________---_-________________________________-______-_-__-____--____-___--------------- I hereby certify th A ave prep re rs ap lication and that +he work will be done in accordance with San Joaquin County9 . ordinances, State laws and rule nd r ulatio of the San`Joaquin Local Health District. ---------- (Signed) -a- ------------ {Owner and/or Contractor B--------------------------------------------- ---------- ----------- ------ (Tit By: (Plot plan. showing size of lot, location of system in relation to wells, b 'dings, etc., can be placed on reverse side). E n FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ----------------------------------------------------------- DATE ------------ 3 --�-------------------------- REVIEWEDBY-----------------------------------------------------------:--------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- ------ DATE------------------------------------------------------------ Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------••---•-----------•----•-----•------ ---------------------------------------------------•--------------•-----------------------------------------------------------------•---------------- ------------------------------•--------------------------------------- --------------------------- •------------------------------------------------------------------------------------------------------------------ - r3 FINAL INSPECTION BY:..--- C1<--------------------- Date-- ----- �-1 - 130 South American Street Stockton, California ES --4-2M Reviseo 1.57 F.P.CO. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California