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OFFICE USE: - ------------------- ------------------- -----------------._............... ...................... r._�5_._-._ APPLICATION FOR SANITATION PERMIT Permit No. _ ---------- ------------- -- ------------ ------ (Complete-in Duplicate) ------- This Permit Exi2ires 1 Year.From Date Issued Date-Issued i 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 AND LOC TIO _�`�___ t Wil...--- -- - ------------- -------------�;------------------ -- ( C_ - ---- - ---------------------- -------- Phone s Name Address - -----------I--------------- ---- -------•--- f -------- - - --------------- Pilon Contractor's Name '------- --=--- - -- -------------- f ' _ Installation will serve: Residence 1% Apar ment House C-] Commercial E] Trailer CV "Iourt E] Motel ❑ Other ❑ Number of livingunits: I-____ Number of bedrooms _ __ _ Number of baths- __._ Lot size ___ f i (�!-f ' -------------- Water Supply:ppy: Publicsystem ommunity system ❑ Private ❑ Depth to Water Table _?S- f# y Character of soil to a depth of 3-feet- Sand ❑ Graver ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ •' _N Previous Application'Made: (If yes,date_-..........------- ) No New Construction: Yes ❑ No W FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ts' Septic'Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ---..._____ ----------------" <-J Size---------- --------- -----------Li Liquid de th--------- ------ - Capacity ❑ No. of compartments-------------------- G p. - P Y------------------- - Disposal Field: Distance from nearest well.WAX.-Distance from foundation__/__..._.._Distance to nearest lot line_____..._ '°{� Number of lines- ONE e �_ Length of each line__. �------.Width of trench--- �t-----------------•--- r Type of filter material. _.._ ____- . _ Depth of filter material___,.-, .-_._ �_ -- Total length - ----------------------- See.page Pit: Distance to nearest weII.AQ-Aja----Distance f m f ndation___ ________ Dis}once to nearest lot line._-� Number of pits__ ..........{_ Lining material • $ize:, Diameter_, XP P------Depth--.! S -6 Cesspool: Distance from nearest well -------------___Distance from foundation___ - -.Lining material------------- _.-___.______.__..___ ❑ Size: Diameter I ------ ----- --------------- Depth - - -----------_-_-----Liquid Capacity-------"-------------------gals. Privy: Distance from nearest well__.._......_.__ .._ _ Distance from nearest building, ❑ Distance to nearest lot line------- Remodeling -----Remodeling and/or repairing (describe):----- - "' -----------••-------------------------- - T. . ars ----• ------------------------------------------------ -------------------------- -- ------------------------- - -------------=---------- ----------------------------------- --- ----------------------------------•--------------- -------------------------------------- -------- - -- --------- I•,hereby certify that I have pyre ptired this appli ation and that the ark will be done in accordance with San Joaquin County • ordinances, State laws, and rules arld,regulations !the San Joaquin cal Health District. ($i ned g ) > o = ...... .. ------- -- ------ -------------- {Owner and/or Contractor) . ?- - - (Title)-- -- ?,,erse ,-------- ... ----- ---- BY:----------------------------------- �(Plot plan, showing size of lot, location of system in relation tow s, buildings, etc., tan be plac on side). t t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - - DATE �1 REVIEWED BY----- --------------------------------r--------------- - --------------------------------------- ------------------- --- DATE ------ BUILDING PERMIT ISSUED DATE.--- - Alterations or recommendations and/ :._. /�.6.� % - ` ® ----------"------------•-•- ............ -------------------- ------------------------ f' ' 0,e--------- ---- �-------------- ------ - --` f - - --` ---,i�.a..�rl_<- r�rc-�t---`-' --------------------- ' ------------ ---------......................................... •-- --.--_...---- --------- --------------------------------- ---------- ------- ............. ' = FINAL INSPECTION BY:-----------------e.1_-- - --"--------------------- Date----- ------- ---------------- SAN 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 E.H.9 2M 1-67 Vanguard Press j?-