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FOR OFFICE USE: ................... ------------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. .,a':.6z.�--....'s ----- ---- ...................""'-.............. (Complete in Duplicate) Date Issued �.1«3. .._............................-----------------------.. This Permit Expires 1 Year From Date Issued 02- _ ((Qp SC/ Application is hereby made to the San Joaquin Local Health District for a permit to cons+ruc and install the work herein described. This application is made in compliant ith County Ordinan 549. JOB ADDRESS OCATION� 1!'4✓. Gi!'�!.. .... --'•.. .............VL"--Osl'- - - - --��'" i"r0�k,. Owner's Name-- Phone --' - ... - -' Address......--' ....... �.. ... . . . ...... --------------- - - ..... - -'- - n. Contractor's Name------ ......... l" `'................... Phone................. - Installation will serve: Residence �Apar+ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units; ...I--- Number of bedrooms._. Number baths7not size ... ................ Water Supply: Public system ❑ Community system ❑ Privateepth to Water Table ... ... f+. 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 ❑ 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation....................Material ............................_.................. ❑ No. of compartments..........................Size............................—Liquid depth---------------------.....Capacity... .-...'--•-"�`- Dispos Field: Distance from nearest well...✓ea.�....Distance from foundation_..._� .1_.-.Dis+ante to nearest logline...- ....._.. Number of lines....._....f.... t . _Length of each line-----IPO_._ .........Width of french----An..f..................... Type of filter material......1�.H. _e_.:..Dapth of filter material.._/.____.___._.Total length..__hP(l.......................... � �i1 i t: Distance to nearest wall.....�.Q...4..�.__..Distance fromfounda+ion__,�� ____._..Distance �o nearest lot li�e..+.r-e_.__...._� ❑ P I......... 9 i ..... Number of rts....... Linin materlal.._..o�_�- - - Size:-9c�rZ:.1�.�tf? .Depth-.-/ Cesspool: Distance from nearest well.................Distance from foundation....................Lining material....... ❑ Size: Diameter-- ....................Depth....----. ---------I---------------._Liquid Capacity............................gals. N Privy: Distance from nearest well............................................. .Distance from nearest building............................... .......__.. ❑ Distance to nearest lot line. Remodeling and/or repairing )describe):....-....._ - - � ' - -- - ' -"'._. . ----- ---- -- - - - - `------------ --- ---------'------------------••----------------'............-------------- ...........................•.... .............. - -................................... 1.....................................................----Y I hereby cert' e+ I have prepared this application and that the work will•be-done-in'accordance with San Joaquin Count ordinances. State la�and rules andqofi +ions of the San Joaquin Local Health District. (Signed) (Owner and/or Contractor) +,, rile (Plot plan, showing size of lot, locatiostem i relation to wells, buildings, etc., can be placed on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY. --- -- DATE...7..^f `.. .::n7t_..............-----'- REVIEWEDBY........_-----------------_---..... --- ...............................................:.....----""-"----------- DATE- ..... ------------...................................... BUILDINGPERMIT ISSUED..... ...................... -""-"' -----""--'- --- DATE-----........................................................ Alterations and/or recommendations:.. ..........................................................................- ......... ....................................................... .......................... ............ ......... ..........................................------...................--"----- ---......--'-- . -- "'-'--""......-"------•"---..._......... ----'-'................. .'.......-- .... _.............. _........................................... ..-_... ..........---•-""'......_... ......' -.........................................'- FINAL INSPECTION BY:...r..... . --- ..... Date....17. u. 417 ......'-" ------'-"-'-'--'--"--..... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 Woo Oak Street 124 Sycamore Street 205 West 91h Street Stockton, California Lodi, California Manteca, California Tracy, California