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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------- -------------------- S,4----------------------------------- (Complete in Duplicate) --- ---------------- ------------------------ This Permit Expires 1 Year From Date Issued 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 Courqy Ordinance No 549 ,Q�LOCATFI ------------------------ -------------------- ---- ---------------- JOB ADDRESS AN --------- Owner's Name---- I ------ -------- -------.-- Phone.--..------------------ ------ 00F ------------------------------------------------------- Address-/4----4 -7----------- -- ------- -----------------4_ .- :0-4/ -Ar Contractor's Name____ ---------- -- ---------------------------V----- ----------------------------------- Phone--' .41 ------------- Installation will serve: Residence F] Apartment House E] Commercial ❑ Trailer Court [] Motel E] Other gel Number of living unifs: --------- N,umber of bedrooms -------- Number of baths -------- Lot size _44 XIIX---/_J)_47�I----------------- Water Supply: Public system [a system El Private E] Depth to Water Table gT ft of 3 4eef:, Sand [j Gravel L] S y Loam ay,Loam [] Clay ��Aclobe Character of soil to a depth El Cl lay j Hardpan C1 Previous Application Made: (If yes,date-------- -- --------) No r�ONew Consfructic,"n'-,Yes �No E] FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I � -from founclation-_'-ko......Mate R -----------Septic T k: Disfan6e from nearest well________________ Distance �a 4(-k�----------------- No. of compartm�12�---!An.... .......... I?e ---Liquid-dep.fh-___'_'/----•------------Capacity-/ Disposal lel Distance from nearest well_��.------Distance from foundation/4)----_-_.Distance to nearest lot line----------------- 0 Number'bf linbs___*�---------- ---------Length of each line__) -1 P-------Width of trench_______ ------------------- Type of filter material-$1-_ --d-e- p )r.De th of filter material-___ ----------Total length------------------F---- ---_-_________ See �n Disfance to nearest lot line-y-------------- Number; ine pa Distance to nearest wel ------Diifanc�94rom foundation-" --_----------- - .0 --1-------------- Numbe� of p;fs------d------------Lining material&0C-/j_"' ---Size: Diameter_02_4------------Depth----- Z------------------- Cesspool: Distance from nearest well----------------�.Distance from foundatlon - ----- ----------Lining material__-_-___----__--____-______-____,____. . . I . El Size: Diameter----------------- --------- ---------Ddpfh------------------------------- ---- ---Liquid Capacity----------------------------gals. Privy: Distance from'nearesf well____-._- : +_____-_----------------- ._Distance from nearest building------------------------------------------ ❑ Distance to nearest ]of line-------------------- -------------------------------------------------------------------------------------- ---------------- ---------- Remodeling and/or repairingld6scr;be):------------- -------------------------------------I----------------------------------------- ----------------------------------------------------- --- --------------------------I--------------------- ------- ---------------------- ----------------------------------------------------------------------------- ---------------------------------------- --------------- ---------------------------------------------------------------- ------------------------------------------------------------I------------------------------- ---------------------------------------------- -- ------------- ------------------------------------ ----------- --------------- ---------- -------------------------I-----I------------------------------------------------------------------------------------------ I hereby certify that I have prepared This application and that the work will be done in accordance with San Joaquin County ordinance fate laws,%and ryles an regulations ofjhe San Joaquin Local Health District. _�t - - 9?, . ..... ..._ A A (Signed)- �0_j ---- ------------------ --- -------------(Owner and/or Contractor) ----------- ------------------- ----------------------------------- By:--------------------------------- -ftolr- ----- _V;_.0-4----------------------------------------- - ----------------------------------------------------------(Title) (Plot plan, showing size of lot,Olocaflon�of sysf in relation to wells, buildings, etc., can be placed ofreverse side). FOR DEPARTMENT USE ONLY ---------------- - APPLICATION ACCEPTED BY----------- ------4--------------------------------------------------- ----- DATE------ --- - REVIEWEDBY--------------------------------------------- ----- ------------------- ------------------------------------------------------ DATE---•---- ------------------------------------------------ BUILDING PERMIT ISSUED------------ ----- DATE--------------t---------- ---------------------- -—--- ----------------------------- P - ____ ----------- ------I----------------- ------I---------- Atferafions and/c�c_recommendations: .7 ------------- ry ---------- ------------------ -------- -—---------------------------- ------------ ------------- --------------------------------------------- ----------- ------- - --- ---------------------------- --------------------------- ------------------- ------------------- ----------------- ------------------- ------ -------- ---------------------------------------------- ------------------------------------ -----------__------------- ------------ ---------- --------- ------ ----- ---------------------------------- ----------------- -------------- ........ ......_----------------------------------- --------------------------------- --_----------------------- ------------------------------------ ---------------------------- FINAL INSPECTION BY:_-_----- Date____- ....................... ------- -------------- -------------------------- - S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.QU.