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FOR OFFICE USE: - /� ...........:....moo-�o-" APPLICATION FOR SANITATION PERMIT � Permit No. .___l._�'�y�`__ -------------------- --- (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 irfstall the work herein described... This application is made in compliance with County Ordinance No. 549. r� /� n JOB ADDRESS AN CATI ---fvt.2,t-0-- -- ------ --------- " '------- tri ' Owner's Name---43 ------------ -- -------- --- --------- -- ---------------•-------- Phone"`4./7" 11____ .i4 ---------------------------------------------------- Contractor's Nam`.- �47 --------------------------------- Phone- W Installation will serve: .Residence r partment House ❑ Co 5m= l ❑ Trailer Court Uqtel ❑ Other Number of living units: -------- ber of bedrooms __Number of baths -__ ot size ___ -__---1-- _t?__ .,_-------------- 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 ardpan ❑ Previous Application Made: (If yes;date....................) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ `} TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r, S c.T from nearest well_________________Distance from foundation___________-_._---Material..____...___-_-.___._._________._.---____._-_._�nce of compartments----- --------------- ---Size--------------------=-----------Liquid depth------------.----- -_---Capacity-----------------------. is t P fe Distance from nearejst well-14 Distance from foundation----/Jo---__.._.Distance to nearest lot line________ 6 Number of lines----_ _---- - -- ------ --Length of each line - r------------Width of trench ------------ W Type of filter materials--_..-.- _ p g � __De Depth of filter matenal______f_�!__Total length ��►�' Seepage Pit: Distance to neare t wept .. ___Distance from foundation----/_0__".___.Distance to nearest lot line_____.__}_._.---- l' I r Number of pits.--�- --"---Lini material-R- . ---------Size: Dia mete r_-5,5`�...__Depth-----Z-�.-________.__ Cesspool: Dis#ante from nearest weli_________________Distance fro foundation--------------------Lining material------.__.__--------____.__.__.._____- ❑ Size: Diameter----- ---------------- --------- ----Depth----: -- - -------------------------- -------------Liquid Capacity---------------------------gals. Z Privy: Distance from nearest well-----_----_-------------------------_------_____Distance from nearest building----------.__.______.________-_____.___.. ❑ Distance to nearest lot line--------- ---------------------------------- ---------------------------------------`------- - --------------------------------------------- T i I Remodeling and/or repairing (describe):--- = ------------------ ---- --------------------------------------------------------- f - ------ --- - ----------- -- -------- -- ---- -- --- f ------------------------------------- ---------------------------- -- ------ -- --- ------------------------------------------------ - "" " kthataye prepared this - ---lication and +hat the rk will be done in accordance" I hereby c rtife p p pp ante with San Joaquin Coun+y ordinances, + laruI nd regulations of the San-Joaquin Local Health District, f {Signed ----� �-, �_' ----- --- --- --- - -a er Contra---------------------------------- ------------ctor) t _____Title By:----------------------------------------•----- --------------------------- --- - --- -- -- { ) (Plot plan, showing size of lot, location of system in relation t wells, buildings, c., can be placed on reverse side): FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ` DATE- 121 REVIEWEDBY------------------------------------ - - ----- ------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED--------p--------- -------------------------------------- DATE----- ------------------------------------------------------- Alterations and/or recommendations:---- ------�r- -G�------ --------------- ----------------------- ---------------------------- ' -----------------•------------ ---------------------"-------------------------------------------------------------------------------------------------"-- ------"--•----"------------------------------------------ -------------- ------------------------------------------------------ - - , --------------------------------------------------------- -------------------------------------------------- --------- -------------------------------- -47 --------- ---- ---------------------------------------------- ---------------------------------------------- Date---_._ .�. G FINAL INSPECTION BY:. J -,f! � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California P.P.C4.