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rvrcrvrril.r uZ)t: ------------- -- ----------------- z_.� J_h'_- �c•APPLICATION FOR SANITATION PERMIT Permit No. ../-----_-_._-/.__ - ---------------------- ----- ------------------- (Complete in Duplicate) aZ� ------------------ --- 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 Ordinance 549. JOB ADDRESS AND OCATION. Owner's Name_ '! /---- ----------- Phone--------------------------•--- Address_----- - - -------------- Contractor's ----- -Contractor's Name______ r_ `'~ r --------.- - .� - ----------�•--•-------------------------�-----------------•----------------------�- Phone------------------ ----------------- Installation will serve: Residence P'"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Number of living units: __/__ Number of bedrooms -_ Number of baths ��_-'___ Lot size _ _ '�' i�'r'____---•--_- �r _ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table �1 f� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gle'OH"ardpan ❑ Previous Application Made: (If yes,date-----------______I No �New Construction: Yes ❑ No g2-'_FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se -c Tan Distance from nearest well-----------------Distance from foundation--------------------Material----------- _________.-______--_- r f No. of compartments- ----- ---r-------------Size--------------------------------Liquid de th--------- ----------------Capacity Disposal Field,: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line_---_-___________ Number of lines-----------------------------------Length of each line------_----------------------"Width of french---------____-- .-----------------•-- Type of filter material--------------- Depth of filter material-----------_-----------Total length___-____-__________----.__-_________-_ Distance to nearest well—AM-1 Pit: D Seepage NI __ -_____Distance fr fo�ndation__,�Q_-_-_.._.Distance to nearest of l'74�f_._-V umber of pits------ ____________Lining material___ _ _Z -_.Size: Diameter__S�� Depth - _ 0 '.Cesspool: Distance from nearest well--------------- from foundation__________________Lining material------------ ❑ Size: Diameter------ ----------------------------- Depth----------------- --- ---------- - - --------------- Liquid Capacity----------------------------9ais` 'Privy: Distance from nearest well----___------------------------------------------Distance from nearest building-------------- S ❑ Distance to nearest lot fine--------------------------------- - ------ -•------ ---------------------- Remodeling and/or repairing (describe):------- ---------- _ _ r •---------- ----- ------------------------------------------- --------- -------------------------------------------------------------------------------------------------- ---------------•------------------------------------------------------------•----------------------- -------•-- ------------------------- --------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------------- - --- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and�arul.esdregulationsof the San Joaquin Local Health District. (Signed) 4 ------- -- -------- -- (�r Contractor) BY: ------------------------------------------------------- -- "---(Title)--- - IL - - (Plot plan, showing size of lot, location of system in relaf o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ �'vF!�. A. y- DATE ------------ - REVIEWEDBY----- --------------------------------------- ----- --------------------------- ---------------------------------------------- DATE----------------------------- ------------------------ -- ----------------------- BUILDING PERMIT ISSUEDr---------------- r t- -_ . DATE----------- Alterations and/or recommendations:._.____, ._ 1- - -_ -------------- --ter 2 - — ----------- ---- =2_r �-` �'--! -z Wiz' /(- ----------------------- -------------------- ---- ----------------------------------------------------------------•--------------------------------------------I------------------------- -------------------------------------_--------------------- --------------------- .-------------- ------------------------------------------ ---------------- ---------------- ----------------- ------------------------------ t FINAL INSPECTION BY:---G: --_--- --- ---� "l Date ------------- `- ---------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street = Stockton,California Lodi,California Manteca,California Tracy,California F.F.CO.