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FOR OFFICE USE: I - -----------------------�-- Permlt No.-------------- -l oAPPLICATIONFOR SANITATION PERMIT--. (Complete in Duplicate) Date Issued ------------------- ----------------------------- ------------------------------------------ This Permit Expires 1 Year From Date Issue 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 LOCATION-------�------- -•------------------------------------------------ r Owner's Name-------- ---------------------------- ---------------- --------------------- ------- Address-------------- -----Address-----"-------- ---------------------------------------------------------------/---------------------e --------------------------------------------- ----------------------" w 1. }� ' � -- ------------ ------- Phone_ - - Contractor's Name---- Installation ame---Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ umber �afbahs - ;. Lot size -----f ----- ------ Number of living units: ____ - Number of bedrooms _ _ _ �pWater Su ly: Public system ❑ Community system ❑ Private pth to Water Table 6_ ft. PP Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: [if yes,date------.__.--__....) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -0 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Distance from nearest well_________________Distance from foundation-------------------Material- _ _____.____.----_____._____-______.._ ...__--__. No. of compartments ----------- --Size----•---------------------------Liquid depth--------------------------Capacity----------- - - I o � . Di saaF-ii isfance from nearest well_/00__.__Distance from foundation_-_. _.._--__ .Distance to nearest lot line___ _ Number of lines-----I__ Length of each line__ Width of tren�}�_-___-_.i _f7�r��-.___--.-_-- .. � 40 . Type of filter mafierial __ -Depth of filter material_.-----a- ��---Total length_____________________ Distance rom f undation_ .._____.Da to e t nearest lot line__ __--_ ip ........-- ePit: Distance to nearest well . _ N Number of pits--_'----------------Lining material___ Size: Diameter__- ->-- -. Depth-___ -------.- -- ee ---------------- Cesspool: Distance from nearest well-________________Distance from undation._._._______.__-- Lining material-_-._____._____- gals. ❑ Size: Diameter--------------------------------------Depth-- --------------------------- ---------------------Liquid Capacity--------- ---------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--__.___._____---_________.._--______- ❑ -- ------------------------------ ---------- Distance to nearest lot ine..____________________ -------.--------------- - Remodeling and/or repairing {describe):__.._-__ ---------- -- -- '04 •-•-- - ° ---- ------ ---- -- ________________________________-�. ___--____ _ ------- ------ ------------- ------------------------------------ --------------------------------------------------------------------------------------------------t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances, St te-laws, 9nd rules a d regulatlons of the San Joaquin Local Healt District. # h 11 � �+rndo�r-Contractor) ------ (Sigr �' l - - c=+ ___ Title By:---------------------:---------------------------------------------------------------- - ------ --------( -------------------- ----------------------- ---------------- (Plot plan, showing size of lot, location of system in relation wells, buildings, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- r ------ DATE--- q'_.-. ---------------------------- REVIEWED BY------- ------------------------------------- ------------ ------------------------ -------------------------------------- DATE-------- - ------------- -- ------------------------------ DATE BUILDING PERMIT ISSUED------------------------------------------------------ _ -- ------------1------ ---------- #^ - -� --`----- --------------- Alterations and/or recommendations .Z} 5- (P . --,------------1- --� I h _ +�- - �- �: - ------------- ----- -------------- c . ------------------------------ --------- -------------------------------- - ------------ --------------------- . Date- - S FINAL INSPECTION BY:_o1---� x�k------- --------------- ---- ---- ;SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haietton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.CC. J^