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FOR OFFICE USE: ------------------ ----------------------• ---•--- APPLICATION FOR SANITATION PERMIT Permit No. ._Ci?�. .................••-•-----..------------------------ (Complete in Duplicate) % ^ / This Permit Expires 1 Year From Date Issued Date Issued ��r 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. 1-1001 yyrsy JOB ADDRESS AND LOCATIO A``r....._ . ---rt-- .. .......... _ ...... Phone.................................... Owner's Nam .........- --•........... ...........r_ ............... Address-------- a � � . •-• >------/ .................................-........... Contractor's Name........... ------• . . .-•...... •_•---- --- -'t................ .. Phone Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ---f___ Number of bedrooms 3_... Number of baths __1-_- Lot size ---------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table --- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam e 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 ank: Distance from nearest well....9P-_".Dista a from foundation..... p_�_....Material_____________________..__.__ No. of compartments.------...........Size_ �� _ _�X�!.Liquid depth-------1. . ...........Capacity...f ��- . 44 Disp Field: Distance from nearest weli...�d...._..Distance from foundation....L.CI..__...._.Distance to nearest lot�ine.5'_�__.... ._. Number of lines.............I-------------------Length of each ----------Width of trench.....Z... .................... Type of filter material.........SRA......Depth of filter material.....L..S�_............Total length-_.._.lid:--•--•---------------•._ Seepaa Pit: Distance to nearest well.......(QO..�Distance fro']j foundation_._..!_D ..._. Distance to nearest lot line....-S.__.._. Number of pits......._.._._._.Lining material..4F.&-4.•---.Size: Diameter.......3.3........Depth____r _S�________________ Cesspool: Distance from nearest well..............::.Distance from foundation--------------------Lining material................................. ❑ Size: Diameter......................................Dept h--------------------------------- ------...------Liquid Capacity..................---.......gals. Privy: Distance from nearest well.................. Distance from nearest building.......................................... ❑ Distance to nearest lot line................................................ ...................................--..................................................... Remodeling and/or repairingydescr:oe):...............•---......_....._ .............................................................................................................. ................................................................................................................................................................. .............-.----.-------------------------------------------------------------•-------•-........................................................... --------------...........................................................................................-•-•------•----•-•-----------•--•---------......----------....•.........................................------• I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, !es and regulations of the San Joaquin Local Health District. (Signed)............. . .......?iAnreiati -----------------------•-- --...-----.......................... „d/or Contractor) $y: [ Title (Plot plan, showin ' e of lot, location of syston t wells, buildings, etc., can be placed on reverse side). FQR DEPARTMENT USE ONLY / APPLICATION ACCEPTED B -Y---• .............................................. DATE-.!�f. .`4_?aK....................................•- REVIEWEDBY............................ DATE_---------------------------------------------------........ BUILDINGPERMIT ISSUED.......................•...................................... -----------.... DATE--------------------------------•------------•---•--------- Alterations and/or recommendations:....................... ..............................................................0. ...........................................................................................................................•-•--•-•--.........._.........--•---•-_... . .................................................._.....................................................................................•-----................---........... .....................................................................---- ............................-............................. ----•-...........---._....----•---•-- FINAL INSPECTION BY:._._!` �"'''` .ar --------------- Date`'7..' '_G SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.tiaielton Ave. 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cq.