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FOR OFFICE USE:,- ------------------------ SE:= --- ------------------------ ---- Permit No. ----- -------------- APPLICATION FOR SANITATION PERMIT z ------------- - _-----____._ � (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date ssue 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 LOCATION__./,-_Sr ----- - ----- _ It ------------------------------------------------- e Phone k6" Owner's Name---- � �-- ��-' ----- = ----------------------•---- -- -------- --- - -- -------- -------- ----- Address ----------------------•---------------- -----•--------------------- ---•----•-------------------•--------------- �-�.: ------------ ---- - -- --------------=-- Phone--------•-------------- -9 - ---------------- - i Contractor's Name-------- - -��-,� -. .. _ .�•�------ ---- ---------- - - . Installation will serve: Residence Zk 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ - Number of bedrooms ___ Number of baths _ -_ Lot slze4-- - -s Water Supply: Public system F1ElCommunity system Private epth to Water Table -_;&t. Character of soil to a depth of 3 feet: Sand ❑ Gravel I[4--5andy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-------------------.1 No [ New Construction: Yes E] No 'FHA/VA. Ys �J ❑ Z�, TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic TanK - . Distance from nearest well____--.__-____--Distance from foundation_______________ Material.__.._____.______.------------------- ------- l0//1-p No. of. compartments------ - ------------ -----Size-- I----------------------- ---Liquid depth------------------ - -----Capacity----------------------- r- 7 i Disposah-Reld: Distance from nearest weft-----------------.Distance from foundation--------------------Distance to nearest lot line____---___-______ Number of lines-----------------------------------Length of each line---------------------------- Width of trench. --------- -- Type of filter material-------------------------Depthtof filter material--------------_-�--._Total length----------------------------- -- p �d ,,,- ________.Distance to nearest lot line__ _.._____.-_ Seepage Pit: Distance to neare,qst we!!_____Q__l; __------ --__Distance fr m fo dation � �pDe th__ Number of pit$02-----------------Lining material _�O Size: Diameter- - p ,��- ----------- ®— t -----Linin Distance from nearest well from foundation_-_.____..-___ d material____.----__--___----------___.-- __ Sze: Diameter_ ---- -----Depth I :---------_----------------_:--- .--- v::Liquid Capacity- -- _ gals. .._�. � k Privy: Distance from nearest well _--------------------Distance from nearest buiiding_- ❑ Distance to nearest lot line ------- --- 9 Remodeling and/or repairing (describe)--------------- r tea_:#_. -------------------------------------------------------- - --- --- - 1 1. ------•----------------- ---- k - - ----------------------------------------i----------------------------------=-------------- ----------------------------------- ---------------------- --------------------------------------------- ------- .I-hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County regulations of t n Joaquin`Local Health District. ordinances, State laws, and rules and -- ----------------------- ----------- ( Or Can#tactor} (Signed}---- 1 6� Title ------------------- - -------------- --- -- -------- { } Y (Plot plan, showing size of lot, location of system i ation to -wells, buildings, etc., can be placed on reverse side). ,.4 FOR DEPARTMENT"USE ONLY tDATE-------- jT------------------------- APPLICATION ACCEPTED REVIEWEDBY-------------------- ------ ----- ---------------------------------------------=------------ -------------------------- --- DATE------ ----------------------------------------------------- t BUILDING PERMIT ISSUE --; ---- ---------------------- "s DATE------ ----------------------- --- - !t ----------------------------------------------------------------- -- Alterations and/or recommendations:--------------------- ----------- ---- -------------- w i a -------------------- ------------------------- --------- ----------------- -------------- f — ------------------------------------ . . FINAL INSPECTION ---- Date ----------------------- SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ho:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street a �, � Lodi,California *.. s Mante[a,Cdlifornio Tracy,California Stockton,California _. _ ""+� t i .4 • "� a' 4r 4 I FA-Ica. r