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r�ttUrrK_t u5E -,---- - ------------------ ----------- ._ APPLICATION FOR SANITATION PERMIT -------Permit No. �.Utj:. --------------------- ------------------- ------- (Complete in Duplicated ':--- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. F This application is'made-in compliance with County Ordinance No. 549. JOB ADDRESS AN CATION--------- --- --- - - e Owner's Na _ ----� i�---_--- ------ - /�� --------------------- - ------------- Phone-------- - - --- - - = Address---------------•----- ----r-X. -------------- Contractor's Name-------------------- --- -- - -- ----------- -- -- -- - ------------ --------- ----- Phone--------- ---•----------•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- ----� Number of bedrooms c2--_ Number of baths Z... Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -daft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2---H-ardpan ❑ Previous Application Made: Ilf yes,date-..---------=-------l No U2'_New Construction: Yes ❑ No [4-'_FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic lank: Distance from nearest well-----------------Distance from foundation__-------- - __--. Material------------------_-----------------___---_----. No. of compartments------ ------------i- ----Size--------------------------------Liquid depth------- --------Capaci#y------------------- Disposal Fid: / } !__ -_Distance from foundation.--` -.�_--.Distance to nearest I/t line_,l ( Number of 1 nesearest well-_ ��'"/ r y�Length of each line-. J�--- Width of trench.s`Z-,-.-- , / �^� Type of filter materiaLy/ f__. Depth of filter material-__f-- ____-_-.-Total length ----------------------eilir------ 00 ---- T pe Distance to nearest well---------------_-____Distance fr m foy�dation__- ��__-__-.Distance to nearest lot li e.- ---.__-._ Number of pits------- ----------Lining material--, � /'�-Size: Diameter.—l"v'-___-__-.Depth,��-� - --- QO Cesspool: Distance from nearest well-------- ------Distance from foundation---_----------------Lining material------- Size: Diameter-------------------- Dept ---------------------Liquid Capacity------- gals. Privy: A,Distance from nearest well._________________----` ---------------------Distance from nearest building------------------------------------- ------------- ❑ Distance to nearest lot line - ----- •- ---------------- - ----------------------------------------------- Remodeling and/or repairing (describe)------------------- f ------------ +� -------------- t - -------------------------------------------------------- ---------------------------------------------------------------------------- ---•-----•-------- -------•--------------------------'------------------------ ----------------------------------------------------------------------------------- ---- ------------------ - 10 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 and regulati ns of the San Jo u' Local Health District. f (Signed) ------------------------------------%mz=nnttor Contractor) E By:----------- ' ------------- -._Ti le (Plot plan, showing size of lot, location of system in relati owe s, uildings, etc., can.�ne placed on reverse side).' FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY. 7. ------- .• -..•`" -'- ------------------------------------- DATE----------- e'-- + REVIEWEDBY------------------------------------------------------------- ---------------------- - - -------------------- - --------- DATE---- ------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------- ----------------- DATE------------------ t Alterations and/or rec ndations------------------ ----------------------------------------------•---•------------- ------------------------------------ ---------- - - ---------------------- -------------- ----------------------------------------------- ---------- --------------------------------------------------I------------------------------------------------------------ FINAL INSPECTION BY:......._ -'��--------------- Date.. � ----------------------------------------- SAN'JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California