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FOR OFFICE USE: =----- --------- �,"3------ APPLICATION FOR SANITATION PERMIT Permit No. i v ------------------------------------------------------ -- r (Complete in Duplicate) Date Issued ................------------__----.--- # This Permit Expires 1 Year From 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, JOB ADDRESS AN y tZlo D L CATION... '_ l / ` U � G � T ---Y•♦- ""-""_- Owner's Name----r---- - --------------------------------------- ----------------- Phone--------------------- ------_------ Address --- !1 ":.J----t...?...... --��----------- = Contractor's Name--• --!-----=--`s--; 3------------------------------------------------------------------------------------------ Phone--------------------------- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- Number of bedrooms _2_ Number of baths _' -:- Lot size ----- ------------------------------------ 7 Water Supply: Public system ❑ Community system ❑, Private [R1"bepth to Water Table aV ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 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 -ark: Distance from nearest well-----------------Distance from foundation-------------------.Material----------------.-.----.-------------- -------__. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth---------- --------------Capacity----------------------- Dispos Fi Distance from nearest wail--FJ.. .__..._Distance from foundation- -1�____.___.Distance to nearest lot line--- Number of lines---------- ---------------------Length of each line_e'oa--_--. ..__---_.Width of trench Type of filter material-_-. QG -.__Depth of filter mafer'iaL_1g..............Total length-- ©d: ---------------------- Seepage -- -_-__-_Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------.Distance to nearest lot line---------------_ -----Linin material------------------ -Size: Diameter-----------------------De th------.--------------- ❑ Number of pits-------------- - g p -------- , Cesspool: Distance from nearest well------------------ from foundation--------------------Lining material------------------------------------- Size: Diameter-------------------------------------De th------------------------ ----- ----- - -----Li Liquid -Capacity ❑ p -- - - q - - -- - - - ----gals. r Privy.. Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- ElDistance to nearest lot line -`----------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)=-- ------ - -------------------------------------------------------------------------------------- ---------------------------------------------------- --- I--! ! i 'l ! 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, and r and regulations of th Sap Joaqui Local .Health District. r, � 1 Owner and/or Contractor (Signed)----------------------- - -, - } --------------------------------------- ( / ) I By E (Tltle)------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED!BY... - --------------------------------------------------------- DATE---11'� —0 --------------------------------- REVIEWEDBY---------------------'-------------------------------------------------------------------------------------------- DATE----- ------ BUILDINGPERMIT ISSUED--------------- -------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendationst------------ --- ---- -------------------_------------------------------------------------•--•-----------------•------------------- .i � -------------------------------•-----------------------------•----------------------- ------------------------------------------------------------------------------------------•-- --------•-------------------------------- l --------------------------------------------- --------------------•- --- ------- -------- ----------------------------------------------------------------------------- ----- ----------------------------- � � FINAL INSPECTION BY:... -- ----- e__2— Date_ �Lr7-- ------ ---- - -- - -------- -- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaxelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street ! i Stockton,California Lodi,California Manteca,California Tracy,California i F.P.Ca.