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FOR OFFICE USE: ----------------- APPLICATION FOR .SANITATION PERMIT Permit No. .�� ------------------------------------------------ - (Complete in Duplicate) ....... This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh 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 . ` -- - --- _j Owner's Name ------ Phone----------------------------------- - ------------------------------------- Address------ Contractor's Name--------•--- •--------------- ------------------------------------------------------------ Phone..--------------------- - Installation will serve: Residence.V?'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-- Number of bedrooms --- Number of baths A.. Lot size -- Water Supply: Public system WKcommunify system ❑ Private ❑ Depth to Water Table 47ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay p Adobe g?"Rardpan ❑ Previous Application Made: (If yes,date. -_ _-.l No New Construction: Yes ❑ No � PHA/VA: Yes �No ❑ t d TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0 r Septic Tank: Distance from nearestw Ir- I___""""-_.--Distance from foundatiion----A______.Mat rial_d__c_ �p No. of compartmeI nts-- ---------------------Size -.. i - Liquid depth------�---------------Capacity AP4cf------- f Disposal Field: Distance from nearest well._ ;Distance from foundation--_�.*�__j_.Distance to nearest lot line-�--s----- w. Number of lines--._'--- -_ Length of each line � �-__/Z7----_.Width of trench-f___.___ Type of filter mate rial/��.._ .:-.--Depth of filter material--- __.__-.Total length_,1,V,'r�i__:_ f _--_ Seepage Pit: Distance to nearest ell____77=-.-----Distance from foundation__ ( ___.Dist n e to nearest lot lipe-to. - ___. ,. [L}� Number of pits----- ---------------Lining material_ -Size; Diameter-s Cesspool: Distance from nearest well-------------__-Distance from foundation------------------- Lining material-------------------------------------- - -_❑n Size: Diameter-----------------------------------.-Depth----------------------------------------- --------.-Liquid Capacity-----------------------------gals. , Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------- ❑ Distance to nearest lot line---------- ---------------------- Remo i' g a or repairi (d ibe):-,,----- _ ? ' y - -------- - - - ------------ - -- --------------- -- -------- - - ------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State Daws, and , les and regul*rsf tate San Joaquin Local Health District. is/ - ---- ----- - r Contractor) (Signed) f(QwAer Ae ) By: -----------•----------------------- Title (Title) /1 ------ ------_--- - --- (Plot plan, showing size of lot, locationofsystemrelation to wells, buildings, etc., can be placed on reverse.side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY = --- /C] ----------------------------------------------------------- DATE-----�� a - - -- ----------------------------- REVIEWED BY----------------------------------- --------- --------- ------------------------------- -------------------------------------- DATE----- ------------------------ BUILDING PERMIT ISSUED------------------- =--------------------------------------------------=------- DATE Alterations and/or recommendations:---Z:�.-lU..: .........al_/(,7/ ]G pC ___ ---•--•----- ------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------- •---------------------- •---------------------------------------------------------------------------------- ----- -------------------------------- ------------_.................... 7--------------- FINAL INSPECTION --- -------yi4;�N;rJOAQUIN -- ----------- Date_------14-n...t :- OL6 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California