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FOR OFFICE USE: .................. ---------------------7------------------ ------------- APPLICATION FOR 'SANITATION PERMIT Permit No. -----------------L------------------------ ---- 7--------- [CoAplete in Duplicate) Date Issued ------ --- --- ------------------- --------- This-Permit EkRires 1'Y69r Fr3i�'Daite .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. - JOB ADDRESS AND LO AT ----- ---- --1-- ---------------- Owner's Nam -------- Pho -------------------- ------------ �fz------------------------------------------------------------------------------------ Address----:2----------- -------- Contractor's Name---_ - --------- L r ----I------------------- -------------- ----------- -------------------------------------------------------------------- Phone----------------------------------- will serve: Residence [Apartment House El Eommercial E] Court E] Motel E] Other ❑ Number of living units: --2--Number of bedroomsf4Number of batheLot size __AX6Cl__.X ___3__a______________________ Water __3__a---------------------- Water Supply: Public system E] Community system stem El 'Private E] Depth to Water Table ??t57ft. Character of soil to a depth of 3 feet: Sand E] Gra ve['E] Sandy Loam �Clay Loom ❑ Clay E] Adobe [] Hardpan C] Previous Application Made. (if yes,date----------- --------) No 65"_New Consfruction:1 Yes 0 No-[nFHA/VA: Yes ❑ No 4"— TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi l-Irank: Distance from nearest we I1 77777-Distance from foundation----?--------------Material------- ------------------------------------- --- No. of compartments--------------------- ---Size-----------------------------.---.Liquid dep.th------------_ - --------Capacity---------------------- !� Disposal R I Distance from nearest well--NO-------Distance from fourdafionA, ..- _Distance to nearest lot line...i5�. es----- 4---------------------- Number of lin ----------- ------------------Length of each line--- -- -----«._____._._.Width of trench ........---- Type of filter material----71q-(,k Depth of filter material-lb--------------- -Total length----f.5"._D------------------ � it: Distance to nearest wellIA?------------Disfamfe from foundafion__/0___,--------Distance to nearest lot kne----------------- Number of pits----------/---------Uning material---5�__.Size: Diarneter__-_Vt_#X_/A_'0__ Depth----/A�------------------------ Cesspool: Distance from nearest;weil-----------------Distance,from foundation...i-------------Lining rnaterial_-------- ----------------------- El Size: Diameter--- -----------------------------Depth---------------------------- - ---- ----- ---------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-----------------------------7------------------Disfance',from nearest building__________._________._____..__..____..- r n ❑ uilding----------------------------------------- El Distance to nearest lot' line ---------- --------------------- -------------------------------------------------------------------- ---_---------------------- Remodeling and/or repairing (describe):------ -------------- --------------- --------------------------------------_----------------I-------------------------------------------------------- ---------------------- ----------------------------------------------------------------------------------- ------------- -------------------------- --------------------------------------------Z------------------ ---------------------------------------------------------------------------------------------------------------------------________________-___________________________________________--____________________________- --- ----------------- ------------------------------ ----------------- -------------------------------------------------Z------------------------------------------------------------------------------- -—------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Vlaws, d es an ...ulat.i s of the San Joaquin Local Health District. .... .. ... ...................................... ........ (Signed)----------- __r------------------ . - --------------- ------------ ---------- ---------. _(Owner and/or Contractor or).. By:-------------------....._._----------------------------------------------------------------------- ----------------------------(Title)---------------------------- -----------_-------- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ -------------------—--------------------------------------------------------- DATE------ REVIEWEDBY-------------------------------------------- -------------------------------_ -----__ DATE----------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ -------------- - DATE---------------------------------------------- -------------- Alterations and/or "mmend a ions: 01--- --- ------ ---------------------------------------------------------------------- -----------------------I------I----------------------------- -------------........ e .... a _ �e�- - ----- .... -- ----------------------------------------------------------------------------------- ---------- --------- -- ----------------------------------- -- ------------------ ------ - --- ---------------------------------- -------------------------- ----------------------------- J------------------------- --------------------------------- --- Z ---------------- -- -------- ----------- ------------------------- --- -------- - ------- --------------------- ------------- ---------------- - --------------------- --- FINAL INSPECTION BY,_ ........ ----------------------- ---------- Date------------------ --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Co.