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-/ FOR OFFICE USE: 6 ------ - q h;► -•.. APPLICATION FOR SANITATION PERMIT Permit No. .1..� (Complete in Duplicate) Date Issued ---�/// s� -._-_----___--------------------------------------------- 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 instal the work herein described. This application is made in compliance with 'County Ordinance No. 549. JOB ADDRESS AN LOCATION..__�2��- �!lM ----------------------------------------------------------------- __-V ------------------------•---------------- Pf: .. ----------------------- ----- ------------- Owner's Name---- ----- Phone Address------------------ -------F--�----------------------------------------------------------------------------------------------------------------------- --------------•--•-------------- Contractor's Name------------��-------Go �� -------- ---- ---------------------------------•----- Phone..----••-------•------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Eff— Number of living units: -------- Number of,bedrooms ---------Number of baths At--- Lot --_-___------------------------- Water Supply: Public system ©Community system [I Private ❑ Depth to Water Table _ d ft. Character of soil to a depth of 3 feet: Sand F] Gravel Ll Sandy Loam ❑ Clay Loam ❑ Clay El Adobe ®Hardpan ❑ Previous Application Made: (if yes,date--------_-.--------) No ❑' New Construction: Yes ❑ No �FHA/VA: Yes ❑ No ®---' TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic_lank: Distance from nearest well_________________Distance from foundation-------------------Material-__-----___-_____.--_--.---________-___--_-__-_- Et�M No. of compartments-------------- ----------Size-------------------- ---- - ---Liquid depth------------------------- Capacity----------------------- p Disposal, Hell Distance from nearest well------- _._-Distance from foundation__�d_�------------Distance to nearest lot line_S.�_-__.._- N, ❑y�c0( Number of lines---I------------------------------Length of each line-_/P&`_----------------Width of trench-4�-�--------------------- a Type of filter material--�u!/: (----------Depth of filter material_J$___"____-__-.-Total length___-_lam_�_________________________ f Seepage Pit: Distance to nearest well----- ___--------Distance from foundation__4Q__f_________-Distance to nearest lot line_____________ 1�r Number of pits----2_. .-----_--_-_ Lining mate r'a _2aGC_____ Size: Diameter-1Z --- .... DeP th_-.. _____________ Cesspool Distance from nearest well ________________Distance from foundation------------------..Lining , material_---------.-__-__----------_-______ Size; Dia --•---------- --------..._Li-Liquid Capacity -------------------- -----gals. . Privy: Distance from nearest well---------------------------------------------- --Distance from nearest building--------_-__-..____________-_____----_ ❑ Distance to nearest lot line------ --------- -------------------------- ------------------------------------------------- -- --------------- -------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------ ---------------------•-------------- --------------•---- ----------------------•-•-----------------------------------•-------------•-•-------------------------------------------------------------------------------------------------------------------------------------------- ---------- -------•- -----------------------------------------------------•-•----------------------------------------------•-----------------•-------- --------------------------------------------------- --------------- -------------------------------------------------------•-------------------------------•-----------------•---------------------------------------`-------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regu1 do s of th San Joaquin Local Health District. [f2 {Owner and/or Contractor] (Signed)----------------�---------------- - --- ---- -------------------------------------------------- ---------------------- ----------------------------------------------(Title)----------------------------------- ---- ... - ----- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-•--- --------------- ----- DATE----- _0_16- ---------------------------- REVIEWEDBY------------------------------------------- --------------------- ----------------------------------- ---- ----------- DA7E BUILDING PERMIT ISSUED------------- d. ---- / - DATE----------------------------------------------------------- - Alterations and/or recommendation /� y ________________________________________________________ - _ _ - ........ _._.- �-__ . `"---- v 6 (� ; '7J�L_.'_"r/'--_._J,._____-_._ ------ ---------- __-._ ------------------------------------_-----------------------•_-.----------.---------------------�__------_ ------------------ ---------------.-_-_-_---------___.._ . ____.-___-. - --------------------------------'----..._-_-.-A300 -__.-_.---.---------.-----------'----------__----------- ..- `'-- ---------- ._-________._._____- FINAL INSPECTION BY:- ---------------- - ------------ bate--- -LT- " ..---1{---------------- -------------------------------- JOAQUIN LOCAL HEALTH DISTRICT 1601. E.Hazelton Ave. t Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California r.n-ca.