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FOR OFFICE U5E: a- ----------- -.- APPLICATION FOR SANITATION PERMIT Permit No. ... ----------------------- -------------------------- (Complete in Duplicate) • Date issued (p � ......................................................... 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 AN LO PATIO - --- --- --1.-Er------z ----------------------------------- ---------------------------------------------------------------------- Owner's Name------ 1. --------- Phone-------------------•---•- Address................•. ---- ------ Contractor's Name--------------- ;y "� ♦l? ---------------------------------------------------------------------- Phone--------------••--------------- -- Installation will serve: Residence [}"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/-_ Number of bedrooms 4!�: Number of baths ___,�__ Lot size r.,1i�_!2Q ------------------------- Water Water Supply: Public system ®Community system ❑ Private ❑ Depth to Water Table -46,0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe hardpan ❑ Previous Application Made: (if yes,date--------------------) No V /New Construction: Yes ❑ No Pa' FHA/VA: Yes ❑ No ®- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Setic Tan : Distance from nearest well-----------------Distance from foundation------------------- Material------------------------------------------------- No. .-._____-______.____-..._--..------_-- ---. No. of compartments-------------------------Size----------------------------•---Liquid depth---- -------- -- ----- - Capacity----------------------- Disposal Field: Distance from nearest well------- ~T_._Distance from foundation----l�-------Distance to nearest lotline__�---_---- ®� Number of lines----------- /�-ength of each line___._ + _______________Width of trench_-_9-- _--------...____--__-__ Type of filter material__ __ .0 ,Depth of filter material----�rtP .__.Total length___( -f_________________________ r 0 Seepage Pit: Distance to nearest well----------------------Distancetion--- --_-_-Distance to nearest lot lint_ Number of pits------- ------Lining material __ - ' _-- __-Si Diameter----��_-__-_.____..DeptI,...A�_ /L' , Cesspool: Distance from nearest well-------- ------Distance from foundation......--------------Lining material----_..-------------------.-__-____ ❑ Size: Diameter--------------------------------------Depth- --------------------------------------------------Liquid Capacity- --------------------------gals. Priv Distance from nearest weft---------------- ________Distance from nearest building ❑ Distance to nearest lot line ---------------------- ------------------------------------------------------- ------------ - . Remodeling and/or repairing ----- G%/ ------Z------ Q f� `,,.''' --------------- - - ------ ------ --------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I -----------------------------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 a d regulations of th®'San Joaquin Local Health District. (Signed)----------------------- ---� ��"-- ------ ------ke1c.., --------------------------------(Owner and/or Contractor) By:---------------------------------------•-•---------------------------- --- --------- -- ----(Title)---------------------------------------- -- - (Plot plan, showing size of lot, location of system in relatio o wells, uildings, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- ".. . . . ------ -- DATE_. Cr GG --------- - REVIEWEDBY ------------------------------------------------------------------------------ DATE---- - ------------------------------------------------ BUILDING PERMIT ISSUED------------- ----- ---------- DATE-- = Alterations and/or recommendations:--� ._ `�' r__ -----------------------------------__- _---..---._ ---------------------------------------------------------------------- - -------------- ----------------------------------------------------------------------------------------------------- ------------------------- ---- ------ .u-------------------------- -------------------------------------------------------------- ---------------------------- ---------------- --------- ------ - -- - ----------------------------------- ----------------•----------------------- ------------------------------ ------------------ ----------- - -------------------- -------- FINAL INSPECTION BY .. -- ---- -------------------- Date.-.....--u�_��"�.Y - ---- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ]24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.00. 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