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FOR OFFICEUSE: APPLICATION-FOR"SANITATION PERMIT Permit No. _ ------------ -- ---------- -------------------------- ---- --- --- ----------------- (Complete in Duplicate) Date Issued ------------------------------ This Permit Expires 1 Year From 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 No. 549. - ; I 1 JOB ADDRESS AND LOCATION._!_ ----------wm&rX-----_-�I ----------: - _' ,l`'--- Owner's Name-------- ---if rs ------------------ -- --------------------------------------- Phone__�72/49rm 2 - Address------------ ra -------- V� �L� ---- ------------- Contractor's Name-------- ! -- cxJE' .�f.•1�� = Phone. Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Motel E] E]Other Number of living units: __.t Number of bedrooms _2,._ Number of bathsLot size _____ _ �"� /....... Water Supply: Public system ❑ , Community system ❑ Private Depth to Water Table $?� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy\Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan El Previous Application Made: (If yes date----------------_--) IN OX New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ N09 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F Septic Tank: Distance from nearest well------------ --Distance from foundation--------------------Material---------------.---------_-_.-__-..-...________- r f x�5 �1 No. of compart!encs--------------------=-----Size--------------------------------Liquid depth--------------------------Capacity-------------------` Disp ield• Distance from nearest well.0.0_--_-.Distance from founclatio f Distance to nearest lot line _._____ ri- - ---------- /_'r( Number of lines�____.__1___ __.._______Length of each line__..__ 0-_______,_.._ Width of trench.___.�� __________ Type of filter material___._ _ p g C/L�____De th of filter material--_-. ___-___dotal length ___________________ -- r .� See ' Pi :/f,J Distance to nearest w ll___ f?_0________Distance m foundation---10_........Distan5e to nearest lot line- - fXI • Number of pits-1-.-_7--.---:--Lining material_--/ OCe_ Size: Diameter___ , p \ Cesspool: Distance from nearest well-----------------Distance from foundstion____--------------- Lining material------------------..____._-_---__--__ ❑ Size: Diameter--=-------- -- ----------------------Depth------------------------------------ --------------Liquid Capacity----------------------------gals. •. Privy: Distance from nearest well----------_--------------------------------------Distance from nearest building-------_---_._..-_-_._________.__...___--- \` ❑ Distance to nearest lot line------------------------------------------- - -------------------------------- ---------------------------- - --------------------------- Remodeling and/or repairing r(descr i be):- ------------------------- r r *he -- -------- - ------------- ---------�---------------------------•- ------------------------------ _r--------------------------------------------------------------- -------------- reby certify hpared this application and that the work will be done in accordance with San Joaquin County ordinances, State law aqd rules aril regulations of a San Joaquin Local Health District. (Signed)------------ j ------- - -- --- -------- ------ -------- -----------------(Owner and/or Contractor) By:-----------------•--------••------- - -�i------------ ---- --- -- ------- ------(Title)---------- ----------- ------------------ --- -------------- (Plot plan, showing size of lot, ocation of system in relation to wells, I ings, etc., can be placed on reverse side). J} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------� ------------------- ------------- DATE-- 7 fill`�`:- '� " REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------I------- BUILDINGPERMIT ISSUED------------------------ ----------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations: =------------•----•-------------------- --•------------------------------- ell -------- ----•--------------------------------------------1 ------------- --------•----------••------------------------ r ------------------------------------ -------------------------------------------------------------------------------------------------- ---------- -- -- ------ -- - -------------- --------- - ---- ----- ----------- -- i s � FINAL INSPECTION BY ...Tt Date--f A� � ' ------------------------- ---- ------------- 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 E. F.P.co.