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FOR OFFI E U E: a .. JLl __---------------------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. .......T-.._.....1 (Complete in Duplicate) �/ (� --------------------------------------- --------------- This Permit Expires 1 Year From Date Issued Date Issue .............,.....---- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. T israpplicaton�is,ma0e 'n compliance with County Ordinance No. 549. On JOB ADDR SS J I P.�T �.Q�w �i ° � �"�D�l!.--------- .�if"�: D LOCATIO p Q Owner's Name-- � � /i Phone Address----------_---.4�....----• ----------- --•-- Contractor's Name--------------- ___- vel--- -•-----. -----••----------------------------------------._._........... Phone-----------•----------•-•-•-------- Installation will serve: Residence g?�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ -Other ❑ Number of living units: .I--- Number of bedrooms _4 Number of baths'-/.. Lot size ; �Q_ '-�. --_•------------------------ Water Supply: Public system [[Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No gg"O` New Construction: Yes ❑ No [9'** FHA/VA: Yes ❑ No ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------- "------Distance fromsfouncla ion..../Q..--------Material-----t1 _.. 4:1- _.ir. . _----_----•-•-. ov No. of compartments------/�___--------------Size_. , , /-_-a_'Liquid depth....3r--- -----------Capacity....PAPO...... : Disposal Field: Disfiance from nearest well...._`~'------Distance from foundation_ _.., t ��..........Distance to nearest lot line---a`I�___..____. Number of lines_______________ ength,of each line--------"� _____________Width of french__._.e ----. -------:........... Type of filter materi , . epth bffilter_mate riaL- _-------Total length...... _.......................... Seepage Pit- Distance to nearest well_-_~"_-'________Distance•fr fou dation_._ r:.:..Distance ioi nearest lot i_me................. Number ofpits_.... ........._--Lining material__` =Size: Diameter- Cesspool: iameter De th. _.. � Cesspool: Distance from nearest-well------------_____Distance from,foundation_- _11 __.Lining mater igl_.------------------- ._...._:__..._.. Size: Diameter-_:_- ------ -------------De th-----'-=------i-- ----` --'-----t7, . . Liuid� �Ca aci ------... gals. Privy- Distance from nearest well----•--------------------------------�~ k g----------------'-----------------•--•--•- Distance to nearest lot line--------------------------'-------------- - ' -= ❑ -- -Die#anc,�s..rom nearest-building Remodeling and/or repairing (describe)___________________ Y_ '�' -Y" .-.___________-__- --=----•-----------•----------------------------------•._..-----••--_--••----------------------------------•---------------- ------------------•----- -------------...------------------------- ----------------------- 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 Health District. Ss reed--------------------- By: •--------- r''`� ----------------------------- ------ or Contractor - � _ {� Plot Ian, showing size'of lot, location of system in tion to wells, buildings, etc.,r'can(be placed o B --------------------------- ------------------------------------------ -- . Title).... ( p reverse side). ' FOR DEPARTMENT USE ONLY r r APPLICATION ACCEPTED BY____� _ --- DATE ---` Z. REVIEWED By------------------------------------------- -- ---•---------------------------------- = DATE------------------------` ------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------••----------_•-----------------_.----------------_ DATE----------- ----------------------•----------'---------------- Aerations and/or recommendations:------ ---------------------------------------------•------------ ---- I% -----------•3------..-.c,' 6- - a =It,,; :::':::- �- - --------------------------------------------------•------------------•------------- ----------------------------- ----------------------------------------i -------------------------------------- --------. . --------------------------------------------------- -----------------------------------------=—c_..................... a FINAL INSPECTION BY:. "".. .g.--� ----------------------------- -- ate--------- :. SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Srrpl 124 Sycamore Street 205 west 9th Street South Stockton,California Lodi,California% %anteca,California Tracy,California % REVISED 8-89 8M 5-61 ASRAS 1 .