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FOR OFFICE USE: ---------� / /��-- ------------- �`'_Od - af� � ------- ------ ------------------------ ---------- 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. JOB ADDRESS PX/ TI —2 4-o ,Owner's Name-_- � _ _. --------- ------------------ At -_.__ Phone__ Address �-�' f P� t f.. f f�'7-e... -------- ,� Contractor's Name � Phone.--- Installation will serve: Residence U:/ICpartment House ❑ Commercia ❑ Trailer Court ❑ Motel ❑ Other y❑ Number of living units: 1_- Number of bedroom__ Number of baths I-___ Lot size -___------__ Water Supply: Public system [Y}""'C.:ommunity system ❑ Private ❑ Depth to Water Table t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,date--------------------I 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.) Distance from nearest well----------------- from foundation----------------.__Material-._._____________.____-_________...________- p� No. of compartments--------------------------Size--------------------------------Li uid de tp---------------------_._-Ca capacity �".. q P Y < is sal f'i d: stance from nearest well� �Distance from found on__ _____ _________Distance to nearest 1 t Eine____ 1J 0 Number of lines____:___ ___ _Length of each line____ ___.___ � Width of trench__- s� _ _��..._._.__.___ D Type of filter materi C- p �� g �C. " De th of filter mater al --___.___Total length l�_"f_"--_----- Seep ge Pit: Distance to nearest well. .. _17`Q—.*-___Distanc m foundation_�__0_______.Distan e to nearest lot line__.___----_ Number of pits______ _____________Lining material- Qlo-u--n-d- afion Size: Diameter _ _..._--Depth_.. ,,. __ ______ l Cesspool: Distance from nearest well-----------------Distance fro .__.-----_--.--....Lining materia-------------------------------------- . El Size: Diameter----- ---- --------------------------Depth-------------- -------------------------------------Liquid Capacity------------ --------------gals. Privy: Distance from nearest well------ --------_---------------------------------Disi-ance from nearest building------------------------------------------ 0 Distance to nearest lot line------------------------------------------------------------------------------------ ------------------------------------------------------- �. r Remodeling and/or repairing �(Asgribe)---------------------- ---- 1 ./ - ------- WY s ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --- 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,-OP,d rules and regulations of the San Joaquin Local Health District. (Signed)-------------2 �' i - - ---- -------------------------------- ---------- Contractor) BYQ9}5-p:-Nuri rAv-e S R1y E------"--------------------------------- -- --- - --- (Title) - ------ -- -------------- (Plot plan, showing sae of lo#;1'6&4M..of system in relation f wells, but dings, +c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- --' -- DATE- -1 �� REVIEWEDBY------------------------------------------------------- --------------- ----------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------- ----------------------..-- Alterationsand/or recommendations-----------------------------------------------------------------------------------------------•--------------------------------------------------------------- -------------------------------------------------------------------------- - ------------------------------------------------------- -------------------------------------------------------------------------------- r 3— 66FINAL INSPECTION BY: Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Colifornio Lodi,California Manteca,California Tracy,California F.P.E O.