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FOR OFFICE USE: b 4 .----------------,� !---------------------- ~ __________ ___ ---------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _.. . ----------I - --------------------------------------- (Complete in Duplicate) / Date Issued -------- - -----------__ This Permit Expires 1 Year From Date Issued __. .___.✓_ �-S Application is hereby made to the San Joaquin Local Health District for a permit to construct an. install the work herein described. This application is m e in compliance with County Ordinance No. 549. JOB ADDRESS A LOCATION_ t ...... 1.1 _- -- �- Owner's Name---- ---------- - Ph o e --- .Address-----------•-----------�-�:_ --- --- -- -- --- - ------------- -- . .. ------- Contractor's Nam -�' !{ Installation will serve: Residence [�partment House ❑ Commercial ❑ Trailer Court [3 Motel ❑ Other ❑ INumber of living units: _I----- Number of bedroom___ Number of baths ;�' Lot size __�I__ _ __ - "". __"_____________ Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam yoam ❑ Clay ❑ Adobe❑ Hardpan ❑ ' Previous Application Made: (If yes,date-- ----------"......) No ❑ New Construction: Yes T No�•❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifbii sewer is available within 200 feet.) Septic Tank: Distance from nearest wellpu _._ Dist e from foundation_-! ____ .---Material .__ A,, No. of com artments_-_ _"- ` p _.. Siz �C __ yLiquid depth_ X-r----_-----CapacitY---- ___ Disposal Fiefd: Distance from near t well_ed- ____ ___------Distance from foundation__/_O-_�.-_.Distance to nearest lot line_.___.,______. ©� Number of lines__ ____________________Length of each line��. -3"`7-._a D_.Width of french.--.. f/--______ - -"---- Type of filter material_ Depth of filter material-__. .��(......Total length___________________ll_L --- LSI Seee 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-------------------------------------- El .._...------ -----._____..__-.❑ Size. Diameter--------------------------. . . .....Depth__._..___________-___________-_-_---__------- -- uid Capacity- --------------------------gals. Privy- Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------- -_"---... ❑ Disfance to nearest lot Pne------------------------------------ - ------ - ------------------------------------------------------------------------- ---- - ---- ------- Remodeling and/or repairing (describe):---------_--------------- ----------------------------------------------------------------------------------------------------------------P-------------------------------------- --------"-------- ---------------------------------------------- ----- --- - ----------------------------------------------"-------•-----------------------------•---------------------------------------------------------------------------------------------------- ------------------------------ 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 re (ions of the San Joaquin Local Health District. (Signed)-----------"----------------------------- ��JJhhd - ----- ------------- --- Contractor yJ ) "E�T7C TANK SI=RVIGf° By: 29-15-E.Unlsr},ve:; : H "�= "g, -------- ---- ------ (Title) ° = --� (Plot plan, showing size of lot, location of system m relation to I , buildings, a c., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ `--- - ---- - ------------ ------------------------------------------- DATE----- - ` - y REVIEWEDBY--------------------------------------------- ------------ ---------------------- ------------------------------------------- DATE------ ------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------- ------..- DATE---------------------------------------- Alterations and/or recommendations:------------------------ -----_---------------- --------------------------------------•-•-------------•-------•----- ------------------------- ----- ------- ----------------------------------------------------------- ------------ -- ----------------------------------------- •------------.------------------------------------------------------------- ------•-------------- ------ -------- -- - - - ---- -------- --------------- ------------------------------------------------------------- ----------------------- - -------------- ----------------------- ---------------------- ---------------------------------------- ----- -- ------ FINAL INSPECT19 �n � •q'tDate-_ •- --- - - ------ l�'------- - -- --------- � -- - ---�----�.�------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracyr California r.P.C u.