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FOR OFFICE USE: / `---- �`-y ��/ Permit No. _._.__�a3 -- ------------- ----------- ....... -------------- APPLICATION FOR SANITATION PERMIT -- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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 Ordinanc 549. A �J -------------------------•---------------------------------- JOB ADDRESS AND LO N. 7Z a-_ _.._ Owner's Name --- . --------- Phone ----------- Address---- ............ ----- �------------------- ------ ----------- -- ------------------------------------� ----=-_-- � - Phone . Contractor's Named / A04,<4 � .Installation will serve: Residence / Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [INumber of living units: __�.__ Number of bedrooms _umber of s _._l_ Lot size ----- -__- ---- ---- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. 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: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e i 7a Distance from nearest well-------------.---Distance from foundation--------------------Material---._____._._----------------------------------- No. of compartments------------ -----------S, g,r------------------:---Liquid dept ---.Capacity------------- ------ pos� Distance from near st well, �._-_ ilance from foundatio ____._/ ` __ Distance to nearest lot line_____._®` �] Number of lines.___I---_-- Length of each line r.._-- ��,Width of trench... ��---.-----t-- '`�-�! Type of filter material-------- I_ Depth of filter material----.----��-..---Tota! length--------�--4------__. -------- Seepage Pit: Distance to nearest well----------- ------Distance from foundation--------.-----------Distance to nearest lot line-----.-.-----__-_ ❑ Number of pits----------------------Lining material.----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---_----------------Lining material-----------------__._____.__-__---- ❑ Size: Diameter-- ------------------ ----------------Depth-------------- -------------------------------------Liquid Capacity------------------------------gals. Cri Privy: Distance from nearest well__--------------- --------------------------- --Distance from nearest building.-.--. ----------------------.-- ------- ❑ Distance to nearest lot line ---- ------------------- ------- ------------------------------------------------- ---------------------------------------------- -------- +� Remodeling and/or repairing (describe)- --------- - ----------------- ---------------=------ - - --------------------- ------;----------------------------------•----•------------------- ------- --- - ---------- -- --------- ----- -- ----------------- --------------------------------------------------- 44 - ------- ---- -- - ---- --- ------ ------------------------------------------ -- I hereby rtify t at I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, laws, /� �le�s reguI do s of the San Joaquin Local Health District. . . (Signed)--- °" "` �: +'°' xaontractor] 111 By:--------------------------------- --------------- ------------------------- - itle -- -------------- - ----- ---- ) (Plot plan, showing size of lot, location of system in relafion o wells, buildings, tc., can be placed an reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---. — ------ - ? _-------------------------------- DATE--------- ` ---- --- / / ° REVIEWEDBY----------------------------------- ------ ----._ DATE ------------- BUILDINGPERMIT ISSUED-------------------------------------------- ------------------------------------------------------- DATE---------------- Alterations and/or recommendations:_-___-_.-.._ n_.._ ��`� ... ----- ---------------- --- -•-- �'`------------------------------------------ �- -�� -- F--cJ- � d --�c c�"=---. ---s-----=-£- --- c_-t � �—e e - -- --------------- ---------- - --------1 ---------FINAL INSPECTION - �7 x Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street w Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC-