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FOR OFFICE USE: i — - - - S --------------- --1(0- ------------------1.G.y APPLICATION FOR SANITATION PERMIT Permit No. .,ls `� . -------------------- --- ----- -- --- ------- -------- (Complete in Duplicate) f This Permit Expires I 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 A CAT! �_�,. - ---'-- ---- Owner's Name------- -----------•------- ----- -------- Phone----------------------------- Address---------------- `_' --------- - Contractor's Name----------------------- -------------- --------------------------------------------- --- Phone----------------------------------- it Installation will serve: Residence �partment House ❑ Commercial )] Trailer Court ❑ Motel 0 Other ❑ Number of living units: _/___}Number of bedrooms -9__ Number of baths /.5--- Lot size ?47xlxf�01 Number Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Tabletsft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ElClay E] Adobe [Hardpan C3 E Previous Application Made: (If yes!dote--------------------) No Pa'�'New Construction: Yes ❑ No 'FHA/VA: Yes ❑ No Kj--r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic`Tan): Distance from nearest well-________________Distance from foundation-------------------Material------------------------------------------- iq�s No. of compartments----- - ----- ------------Size--------------------------------Liquid depth------------------------Capacity------------- ------ 1_11 _ f Disposal Field: Distance from nearest well__Af------Distance from faundation__Z�__.------Distance to nearest lot line_ _____________ Number of lines----------- Length of each line____ , _'--------------Width of trench_.r ---___.__._________________ Depth of filter mate ria len th---_- _� _-- Type of filter material--��_- p length----.-: ------------------------ 'd 0 Seepage Pit: Distance to nearest we_II;,__R�.--------Distance fro foundation___,4,Q___._-_. Distance to nearest lot line..*0.._______._ .�- Number of pits / __Linin materiaL_ -Ae*_.Size: Diameter__ -. Depth ,. r it ----- g - �- ----- P � At f- : es p� Distance from nearest well-----------------Distance from foundation....- --_ _------- g -Linin material--- --------------------------------- ❑ - Size: Diameter- -- ------------------------------Depth---------------------------------------------------Liquid Capacity------------------------- - gals. Privy: Distance from nearest well__________________.______-__ ______Diatance`from nearest building_._-_-____;__._____________.--___--- Cl Distance to nearest lot line-- "Owr ----------------------------------- ------------------------------------------------- ... ------------------- r Remodeling and/or repairing (desclibe}-------------- �-•----------•---....._I-•---- --------------------------�--------------------------------------------------------------- ----------------------------------------------------------------------------------- O aI 1 ..----------- , 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, ao rules grid r4dations of the San Joaquin Local Health District. _16(Signed)----------- -- ------- ---- - - ----- - -------- ----=----------------------------- /or Contractor) I B ------------------------- -- -_-- Title ,�-,�A ��. -------_--- --------------- Y•------------------- ( }--LT'S - (Plot plan, showing size of lot, location of system ' elation to wells, buildings, etc.-,--can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY---- i -------------------------------------------------------------------------------- DATE ----------------------------- REVIEWEDBY-------------------------------- ----------------- ---------------------------- -----------------------`----------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------I-------------------- ----- ------------------------------------------------------------ DATE-------------------------------------- ---------------------- Alterations --------------------- mmendations:----------------=----------------------------- ------------------------------------------------------------------------------------------------------- AW rams 6 .Lo - 10 r rec d'1 C ----------------------------------------------•----=--------------------------------------------------------------------------I-------------------------------------- ------------------------------------------------------- .i------------------------- -------------------------- ---------------- - FINAL INSPECTION BY:...._.-.-cC1 q---- - ------------- ----------------- ---- Date-- --, '. = 5^ ------ - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street .724 Sycamore4Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P-CO.