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FOR OFFICE USE: ------------------------------ -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _ - 1... _.. (Complete in Duplicate) Date Issued --_ - ---------------------------------- -----.-__-.-.-.-..__ This Permit Expires 1 Year From Date Issued Application is hereby made to the Sats Joaquin Local Health District for a permit to construct and install the work herein clescrbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO TION_wa_6-a__-- - ._ l�' 4 ---•---------------------- --------------------------- Owner's Name--- --- ---- -- ------- - --- - --------------•-•--------------- - - ------------------------------------------------ --- Phone------------------------------------ Address---- --- Contractor's Name-------------- - ---• ------ --------------------------------------------•----------------------------•--- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [) Motel ❑ Other ❑ Number of living units: _/.- Number of bedrooms A;ee�:'Number of baths Lot size02'!W/W-- ------------- Water Supply: Public system ❑ Community system ❑ Private KIDpth to Water Table ---ywft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U00OH ardpan ❑ IN Previous Application Made: (If yes,date----------- ._.-_-.) No Rpo"'New Construction: Yes ❑ No FHA/VA: Yes Ado ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q ■ `JL] Septic Tank: . Distance from nearest well-_ -Distance from foundation-- -_ -----------Material--------------- ---------------------------------- rpNo. of compartments----------- - -----------Size-------------- -------------_---Liquid depth---------------- ------- -Capacity------------------- --- isosal Field:v Distance from nearest well.---- J-------Distance from foundation--------------------Distance to nearest lot line-------.---__---. k'3 f 11jj Number of lines-----------------------------------Length of each line------ ----.-.Width of trench-------------:--------------------- \M Type of filter material-------------------------Depth of filter material----------------------Total length-------------------------------.-_------- Seepage Pit: Distance to nearest well_..;?_bV.____--Distance fro foundation_-_ --- -- p 4 le to nearest lot lin --- ---- ------ ---Linin material.-- - 0 - Size: Diameter_ Number of pits------f-------- g �'--•��---�........Depth.oC.%7----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter ---------- - -------- Depth----------------------------- :-._LiquC id apacity-- ---------1-1-gals...- Privy: Distance from nearest well--------------------------- --------------------Distance from nearest building---------------------------------------... ❑ Distance to nearest lot line------ -- ------------ - -- ---- ----------- --------------------- ----------------------------------------------------------------------- - IV Remodeling and/or repairing (describe)-------------------- ------- life , ' ------------------------------ ------------------------------------------------------- :__-___:_ ----------=------ -------------------------- --------------------------------------------- --------- 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 regulations of the San Joa uin Local Health District. (Signed)------------------------•----------- ---X- e-! .-.._— --- ---- -�--�- --- - --------------------------------------------- Contractor) B -----••---------------------------------------- ------ (Title) l. ----------- -- ----------.--- Y (Plot plan, showing size of lot, location of sy in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- -- - ----------I-- --- -•- --- - ------------- ---------------------------------------- DATE ---- e' REVIEWEDBY----------------------- W-a----------------_ ----------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------ ------------------------ -------------------------------------------------------------._ DATE--------- -------------- :_ --- _ Alterationsand/or recommendations:---------------------------------- - ----------------------------------------- ------------------------------------------•------------------------------- ---------------------------------------- --- ---------------------------- - ----------------------------- ----- ----------- ----------------------- ---------------------------------------------------- FINAL INSPECTION BY: ' Date-.v_-_�j4 ---- --- ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.C C.