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I-PR PFFICE USE: ---- ---------------------- ---------- ------ --------- APPLICATION FOR SANITATION PERMIT Permit No. ------------I -- ---------- ------------- (Complete in Duplicate) ---------------------------------- -------------- - This Permit Expires.-I Year From Date Issued Date Issued Application is hereby made to the 'Son 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. .0 L,4 JOB ADDRESS AN�� Tl ----------------0 - ------------------------------------------------------- ... ...... Owner' Phone-em- s Name--.---C _ 4 --- ---------- ----------- --- ... .... -- ---------------------- --- - --------- ► Address----------------- 0 Contractor's Name---------------------------i —---------- Phorw Installation will serve: Residence jL Apartment House L] Commercial [-] Trailer Court Motel El Other El Number of living units: Number of bedrooms -----.-- Number of baths -------- Lot size ...... — Water Supply: Public system --------------------- Community system E] Private E] Depth to Wafer Table 0.0- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Ej Clay Loam [] Clay [-] AdobeKHardpan C3 Previous Application Made: (If yes,I�dcite---7----------- ---) No K New Construction: Yes 0 No N. 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 r1arest we I-----------------Distance from foundation--------------------Material-------------- El ff,�t�4J6 No. of compartnents--------------------------S'Ize---------------------------- ---Liquid depth...------------- ---------Capacity-------------- -------- Disposal Field: Distance from nearest well-AAAQ--Distance from foundation-_---.-----_-..Distance to nearest lot line--- Number of ---Length of each -Q--.'___--------_-Width of trench---Z-4t-!l Type of filter material-1 ---Depth of filter material____.`___ --------Total length-----24--------------------------- Seepage Pit: Distance to nearest well-1VOW(E--Disfance clation----—------- Distance t6 nearest lot line--.3S------- -0 Number of 61). -Lining material ..........Size: Diameter.4 ir -"Of r ---Depth----7-----7- ---------- Cesspool: Distance from nearest wali-----------------Distance from foundation.----.-..-.-_ - Lining material....---.....------_--__.__-- El Size: D;arneter--- ------------------- ----------Depth-------- ----------------------- -------------Liquid Capacity--------------------------..gals.- - E Privy: Distance from nearest well----------------------_---_...--_ . ........Distance from nearest huiiding------------------------------ ElDistance to nearest lot line------------------------------ -------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------ ---- - --- ---- ^---------------- - ------- - --------- I-------- -------------------- ---------- ----- - ----------- ----------- -------------------------------------------- ---------------------------------------- --------------------- ---- --- --------I--------- --------- ------------------------------ ------------------------------------ I------------------------- -45�&- - ------- ---- ---- - ------------------------------------------ --------------- -------------------------------------- --- --------------- ------------------------------4------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ 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, rules and regulaffins of the San Join Local Health District. Z.. (Signed)---------------------- 7 - - - ------------ (Owner and/or Contractor) I- ------------ ----------- ...... ---------------- .... ....... By:--------------------------------- --- --- buildings,... .... ..........(Title)---- t1.1 AAf (Plot plan, showing size of lot, location of system in relatiolto wells, buildings, etc., can be pla verse side). I . A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -C-JWr- ! ....0 - 6 ------------------------- ------------------------------------------- DATE--/----2... ........4 REVIEWEDBY-----------------------------------------------i - ---------------------------------------------------------..... TE / ................................. BUILDING PERMIT ISSUED-----------------I ------------------- RATE__. ------------------------------------------------------- ----------------/---- --------- n s: ---------- ------ ------ --------- ATE • Alterations and/or recommenda'i ---------k-e- --�---------- IV------------ ........�44-------e -17--------/-- ------- --------;90v--h� ..................... ---------------------- ------------------ ----------------------------------------------------------------- --- ---------- ------------------------------ ------- -------------------- ---------------------------------------- ---------------- -- ----------------------------- -- -------------------------------------------------------------------------------------------------- --- ----------------------- FINAL INSPECTION BY:.,----- -- ---- -------- -------------------------- Date.--- ASAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California 1 Lodi,California Manteca,California Tracy,California F.P.C 0.