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FOR OFFICE USE: r` -fy�� -------------------- , -W '' APPLICATION FOR SANITATION PERMIT Permit Na_ ________________________ {Complete in Duplicate) y � -� u _ 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. f ! 47, 1 JOB ADDRESS AND'LOCATION ------- r1/ ------- '------ -'P �, -� i Owner's Name--- :--•--- vf� �_..-. - _ =---------------- ----------------------- Phone------------------------------------ Address--------------'---------------------------- --------------------------------------------------....---------------------------------- Contractor's Name: 1� 1 `e`� - - ------------ Phone----------------------------------- Installation will serve: Residenee Apartment House ❑ Commercial 0 Trailer Court ❑ . Motel ❑ Other Number of-'living units:-_. -_ Number of bedrooms -------- Number of baths -------- Lot size ----------------------------- -- Water Su I Public system Community system'❑' Private Depth to Water Table --_--_ ft. PP Y• Y D Y 1 z a Character of soil to a'dep' fh of 3 feet: Sande Gravel ELl Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2"' Hardpan ❑ I Previous Application Made: (H yes,date---------------_---.J lNo New Construction: Yes ❑ No ❑/i A/VA: Yes ❑ No Z_ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic 'tank or cesspool permitted,if.public sewer is available within 200 feet,) Septic Tank: Distance from nearest welt`"-"----- ---Distance-feorii-joundation------------"' :Material=_---"`-_--""•`"" No. of compartments----- ---- -----��'=Size-------- -_-----------Liquid depth---------------- -----. Capacity-- .- ---- jr -`� -- - *` Distance from foundati�,_^-/�_-_ -.-.,,DNista hcefttrench est lof�I�ne:.. 7 Dispos�Field: . ; Distance from naret`well .°::-- .- r f ❑ . 15� //d/ Number of lines . . .--:.T' tiength,ofreach�l�ne - 'S- --- ------ idt o � ;� �. 7 ,.� y s rai �,Typeyof fiifer material J& of filter material--- -r.----Total length- '>_�:_ 7�------------------ Seepage-Pit; Distance to nearog-well - �� - - Ulstance fromfounda /_tion--- v_ Dis ante to nearest lot liner------"----"- i Depth _ --/- --rt_ --_Nunberr of ----Lining Diamete//�/lCesso 7 il Distance from- nearest well----------------=Distance-from-foundation-----.......---E�ining-material_.---_---.--_L!--.--.-.-/----_-- � Size: Diameter.---- :- ==""' 'Depth -------------- --------Liquid Capacity- -------------------------gals. Privy. Distance from. nearest nea-rest we�l----- - -.Distancefronmnearest t building "------------------- ❑ Distance to nearest lot line------------ -- "----------------------- t � 1� -�----- - - ---- . -- - -- ------- ---- -describRemodelin9 and/or repairing ------- -=-----•----•------------------------------------------------------------------------- --------------- -------------------------------------- C -- 1 ---------------------------------------------- =----------I--------- ------•------------I----------....------------------------------------------- --- - 1 herebycertifythat I have re ordinances, State laws, an ules dared this application and that the work will be done in accordance with San Joaquin County —� anI etrig—juletio s;f theTS-an-4oayuin-L--crcal-Health-Districf. 4 -----.--_----------- - Owner and/or Contractor -. - ) (Signed)----------•-------- ----- -I - BY ` '' ----[Title)---- «Gf [Plot plan, showing size of lot, ion of system in relation to wells, buildings, etc., can be placed on reverse side). f t3 y ,.r FOR DEPARTMENT USE ONLY < APPLICATION ACCEPTED BY" ! / ------ --------- - --- --------------- ------ -------------------------- ---- DATE.---------- - ��- ---------- REVIEWEDBY-----------•------------ - ------------------------------------- " --=-- DATE------------------------- --------------------------------- BUILDING ----------------------------- "BUILDING PERMIT ISSUED-------------------------------- --------------------------• --------------------------------- DATE Alterations and/or recommen. a do ' - - ----------------------------=-------------------------- ------------------- -------------------------------- -------------- ` -- --------------- -------------------- ----------------------------------•-------------------------------------------------------------- ----------------------------------- ----------------------------------" ------------ ...... ----------------------------;- IF -------------- ------------------------------_;---- ---------------------- ------------- ------------- -- y F1NALINSPECTION BY:.----" ---------------------------- ------ :Date------ ---------------------- --- --- --- ------------------------------------- :� , , SAN JOAQUIN'ILO.CAL�HEAl.TH DISTRICT 1601 E.Ha:e[ton Ave. 300 West Oak Street, .,,. 1 2$Sycamore Street 205 West 9th Street Stockton,California Lodi,CaliforniaMariteca,'California Tracy,California r.P.c o. -T.....