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FOR OFFICE USE: S5S ------ --------------- Permit_No. .._... APPLICATION FOR SANITATION PERMIT , ..-------------- ------------------ �. (Complete in Duplicate) Date Issued ----------------------- ------------------ - This Permit Expires I Year From Date Issuedk-• 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 No. 549. ..< JOB ADDRESS AND LOCATION------------------------------------------------------------ ---- ______.___,_ .__ Phone---------------------------•-------- • Owners Name_ -----•--------------------'-A--------•------------ -- ------------- - Address „---------•-- - ----------------------- P ractor's Name �`�- "° = ! -------------- --------------------- Contone. Motel Other -------------•-- tti Installation will serve: Residence ❑ Apartment House ❑ Commercial d Trailer Court ❑ ❑ ❑ ` ---------------------------------- Number of liv'sng units: f -____ Number of bedrooms _.______ Number of baths _ ______ Lot size __________________.____.- Water Supply: blic�system ❑ Community system ❑ Private ❑ Depths to Water Table -------- ft. .. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ eCl y�Loam El Clay E] Adobe❑ Hardpan ❑ \, Previous Application Made: (If yes,date.__..___._,____-._1 No G New Construction:?Yes El No E] FNA/VA: Yes ❑ ° No ❑ .: TYPE OF INSTALLATION AND SPECIFICATIONS:,--v'" Distance from nearest well______ ________"-Distance from foundation-----------_________.M iy-_(.No septic.tank or cesspool-permifted if-public-sewer is available within-200 feet Septic Tank: D f ` saterial--------------------------- ❑ No. of compartments-----------\------------Size---------- :---- ---:---Liquid depth Capacity Disposal Reid: Distance from nearest well____.\..........Distance from foundation__.____-----\-_.Distance to nearest lot line_________________ Numbe'r(of lines-------- -- 1---------Length of each line-------------------'.:---"- -Width of trench.------------ ---------------- ❑ ♦ �. �( Type or filter Material___---=--4`--L�_-----Depth of filter matenaL--------------�--.---`oto engt ___.______-_------- - -----: ---•------- Seepage Pit: Distance to nearest well----- ---------------Distance-Frem found -------Distance to nearest lot line_________________ 0 Number of pits---------- ----------Lining material-----.- --------- ----Size: Diameter t-------:---- Depth - t I "material Cesspool: ,! Distance from nearest well-________1__.___Distance from foundation...________}}.______.Lining ___________________._._____________. j Size: Mameter--- ---------- Depth f Dish e fraizt' nearest ill Capacity gals. ❑ '' I ; TO buildin Pri y'- -v j Distance from nearest-well---- ------------ -------------------------------------------- Privy', --------------------------- - ---- ❑ _ . _ —_ .h i -------------------- ---------------------- 1\ I ` Distance fo nearest lot line- - ---- ---- ----------- ------------------•------------------- -------------- ----- r ,.,• �. - r*� J i .- __ - - - -- ----------- .� � r-- - - -%- Remodeling ind/or] *repairing-{desSibe): ________•----------- '` _ -�----- I J1, ii 1 = - -- -- --------------------------------- - --_- I hereby .cedify that-I have prepared-this application and hat-the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. J� { (Signed) ---- ------------------------------- ---------------------------------"---------------------- ----------------------------------(Owner and/or Contractor) ----------------- - - (Title) l T(PI� an, showing size of lot, location of system in relation to wells, buildin s, etc., can be placed on reverse side]. a FOR DEPARTMENT USE ONLY 5 t APPLICATION AOLEPTEDt BY---- - --=-- ------------------------ --------------------------- DATE- ---------------------- -- -------------------- _._._._ " t �Y .. DATE---- ------------------'----------•----------------------- REVIEWED l "--------- ----`--%- - ------------------------"------------ -------------------------- B -"'- ----------------------•-- BUILDINGPERMIT ISSUED----------------------------------t----------------------------------------------------------------- DATE Alterafions-and/or-recommendations:__,-...----- «=----=--- -=-=---- ------•------------------------------ ------------- ----------------------------- ----------- ----- --- ----- - - r T .... a -s4r --� Y ---------------------------_.__.------------------------------- .� _______________________________________________________________________________________ F ---------------------- -------- -- Date------------------------------ --- ------------------------------- ---------- FINAL INSPECTION BY-------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT G� 1601 2.ka:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California > F.P.CO.