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�• FOR OFFICE USE: i �1. 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 tl'e-work herein descbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND 'LOCATION �S' � � fia�'.�----- _ /E �7 Owner's Name-----------/jr _._ -------------- --------- -------------- --=-------------------------------- ---- Phone------------------------------------ ------ Address IF Contractor's Name------, ..� WrF ------------------------------ -- - - ---- ---------=-------------------- Phone----------------------------------- Instailation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms --- Number of baths ___.__._ Lot size _ �/� . Water Supply: Public system ❑ Community system ❑ ,Private epth to Water Table ,eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® lay ❑ Adobe ❑ Hardpan Previous Application Made: {If yes,date_________ __-------_) Noi�New Construction: Yes ❑ No ®SHA/VA: Yes ❑ No ❑- d E TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tarik: Distance from nearest well-----------------Distance from foundation--------------------Material ___.____________.___.._____.____tik No. of compartments----- --------------------Size--------- '-----Liquid depth----------------- ----- -Capacity----------------------�j -. Disposal Field:.- Distance from nearest well..`e_�__Distance from foundation---A�_._�__..Distance to nearest lot line_r�__�___� 4,4�f Number of lines'----------------- Length of each line__/,�V- -- -----------Width of trench��.-__ ___-_�_.._______.___'14 4� f �r Type of filter materiapl' Depth of filter matenal____� __.__-__Total length___, ________ Seepage, Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line__.__.__________- /"[ ' Number ofpits-7 ` --------------L.ining material----------------------Size: Diameter-----------------------Depth--------------------------------Cesspool: Distance from'nearest'-well-----------------Distance from foundation_..________._____.Lining material------------------------------------- i 0 Size: Diameter----�-----%70------------------- ---Depfh--------------------- ---------------------- -.----Liquid Capacity--------- ------------gals. Privy: Distance from nearest well------------------------------------------------.-Distance from nearest building-----------------------------------.___._- ❑ Distance to nearest lot line =------------------------------------------------ ' # Remodeling and/or repairing (d - escribe):--------------A "'�-------------, 1" - ------ ------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ----- f 4 ------------------------------- --------------------"-------------------------------------'----------------------------------------- ------------------------•---------- -- --------- --- -------------------------------�-----------------------------------------'----------------------------- 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, and rules and regulations of the San Joaquin Local Healfh District. ,rte- ---------------------------------------- r Contractor (Signed)------------------------ - (4" ¢e., 4 B --------------------------------------}----------------- d� ]------------------ .......` t� s!" ` Y T W," _ -- '(Plot plan, showing size of lot, location of system i atiori to wells, buildings, etc., can be placed on reverse side). t r FOR DEPARTMENT USE ONLY E APPLICATION ACCEPTED BY........ ......` - ------- ----- -----.---- ---------------------------------------- DATE--------- REVIEWED BY s ---------------------- -` DATE - ---------------------------- BUILDINGPERMIT ISSUED-------------------i-----.-.._.=-•------------- ---------------------------------------------- DATE------------------------------------------------------------- i IAlterationsand/or recommendations: ------------ ----------------------------------------- ------------------------------------------•---------------------------------- , .... ------------------- ----------------- -------------------------------------------------------------- ----------------- - ----------------- -- --- ---- --- ------------------------------ ___________----------------------------------_-------------------_________------______________________________________________________________________________________________________________________________________________ M H --------------------------------------_----------------------_______---------_-_.-_..----------------------------------------------_--------------------------------------------_---------.---------------------------------- i -------------------------_----_------__----_-_--------------------------------.----------------_----__...____----------------------------------_------------------------------------------------------------------------------ FINAL INSPECTION 8Y:_._._...__P'p�,_Y�� --------- Date---------------`s_ �� ------------------- SAN JO AQUIN'�LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California ' Tracy,California F.P.E:m i