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VQL: L -------- - ---------------- --------j APPLICATION FOR SANITATION PERMIT Permit No.------------------------------------ (Complete in Duplicatel 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 County Ordinance No. 549. t�3P,2 ti- �fdB� �. 0�3- 2-s0-c9 JOB ADDRESS AND LO ATION_` Owner's Name"_______" .__. __ --- �� Address--......... --- - ----- Phone - ------------------------ ----- - - -f�---------- �?d ---------------•----------------------------------------------------------------------•--------------------- Contractor's Name--------_ �_�,.� "� - Installation will serve: Residence (Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ' Number of living units: ___L Number of bedrooms -A-_ Number of baths _ ❑ { �_ Lot size Water SuPPI • Public system ❑ Community system ❑ Private IR"nepth to Water Table _ f+. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Previous Application Made: (If yes,dote--------------------) No E] 0 ❑ FHA/VA: YYes No New Construction: Yes No El Adobe es yg-23-'Hardpan o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: E](No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: / Distance from nearest welt---------------- w _Distance from foundation__._______"_----__-.Materiaf-..______---_---"__-."_-"""--__--" ------" 40910A No. of compartments- ------------------------size------------------ - ------------Liquid depth--------------------------Capacity----------------------- -- Disposal Fyelcl: Distance from nearest weli._-,QQ�Distance from foundation-_02-��---.Distance to nearest lot line_--r-__--- N Number of lines________ ___. 4. --- -=-- -- ___ • Len Length .of each line___ .- _ �- g -- ----- Width of trench..2 ✓ Type of filter material� �--- -- ��------- ---------- " fDepth of filter material__ _ offal length-- .;/.-- ----------------------- Seepage Pit: Distance to nearest well_Z-Q ------Distance f m fo dation N p__._._.Dista e to nearest lot line__.?---,_-.- Number of pits _---_--. --Lining material__ .- .5+ze: Diameter-------------- -------- Cesspool: -- - ---- ------- Distance from nearest well-----------------Distance from foundation"---- ............Lining material__--______-_-_ El Size: Diameter_- Depth----------- ----------------------- ---------------Liquid Capacity- ------------------------gals. Privy: Distance from nearest well------- ----------- --------------- --------------Distance from nearest building ❑ Distance to nearest lot line__._-__________________.__ Remodeling and/or repairing (describe:---------awv ___ - __ - ----- --- ---------------------- ------------------------------------------------------- ------------ ---------------------------- ------- -------------------------------------------------------------------•---------------------------------------------------------------------- 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 rul s and regulations of he San Joaquin Local Hea h District. (Signed)----------------- - 'f, w _ -- --- — - -_- BY---•---------------- -------- •-- •---------------•--------- ----------- - --- Title-- ----------------------------- _or Contractor) _ _ (Plot plan, showing size of lot, location of system in r n ells, buildings, etc., canbeplaced on reverse ),-- — -� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y__- . DATE. '__ ------------------------------- BUILDING ------ --- ---- REVIEWED BY------------ -- -------- ------ --- ---------- ---------- - - - - - ---------- - ------------------ -------------------------------------- DATE PERMIT ISSUED------------------------"-- - �--------- - -- ------------------------•--------------- --------- DATE-------------------- --- Alterations and/or recommendations:-_______-." ......... ....... .............. ---------------------- ------------- ----------------------- -•------------ FINAL INSPECTION BY---- - -- --- ----_ � i --- ---- --- -------- - -------- Date-- •=� ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California F.P.1211, Manteca, California� Tracy,California I