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FOR OFF;CE USE: __ � � -- -=-- ----------------------- ----- - it No. '---••---------...---- - APPLICATION FOR SANITATION PERMIT ---------------- ----------- -------- -- --'=--- ------------- (Complete in Duplicate) Date Issued 1-.^_2 ---------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to co ST uct nd instal' w rk herein described. This ap lication-is,,�m,ade in compliance with County rdinante No. 549. �� t " JOB ADDRESS AND• CATION-------- `�✓` - - --�-'-- /2. s.� -------- f Owner's Name---------- -.. �� =�r � ... Phone t �� y ---------- ---- --- ---- -- :------------- I - - Address " r f .P 1 "__ Phone__ Contractors Name.-- '---- •- --- •- ------ Contractor's ❑ Other Installation will serve: Residence;' partment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units: __. --_ Number of bedrooms _ � �' ..""""""""""" -------- Water Number of _ _-_._ Lot size .. ._"_._____: __ Water Supply: Public system ❑ Community system ❑ Private ® Depth to er Table -------- ft. ' Cp haracter of soil to a de th of 3 feet: Sand E] Gravel F1Sandy Loam Clay Loam ElClay ❑ Adobe E] Hardpan ❑ Previous Application Made: (If yes,date-_ ------ 1 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.) Material-- d _� 5 ti. T k: Distance from nearest wel4 ----- --Distance from found g�1____ �7� Size__ f Li uid de thy'-F f�" Ca acit /.,t� ._. ( No. of compartments ---..-�-------------i d � -----� G � P Y ----- ... Distance from foundation'_-�_.�._____-Distance to nearest lot lin`e�____ Length of each lines-Q--------------�----.Width of trench.-- .----- ----- nce from ter�a_ is os Fiel Nluma6e{ {ilte lines we 1 �r Total len th ------"--- Type o I',� _-Depth of filter material---..-�-�-------- g�---------- ------------ Seepage Pit: Distance to nearest well------ -------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------- ---------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.--_----- .____---.._.._--.----- Size: Diameter----- - ----------------- ----------Depth------ ---------------------------------------------Liquid Capacity--------------------- gals. Privy: --: Distance from nearest well..-.- ------------------------------------------Distance from nearesf building------------------------------------------- ❑ Distance to nearest lot line----------------- --- ------------- --------------- ------------------------------------- - Remodeling and/or repairing (describe--------------------- :_... --- --- -------- ------------'----- ------- �;`� --- ------------------------------- ------- _ .W ' ` � a� � .---------------------------- ------------ ---------------- - ----------- ---------- ---- ------ ------------------ ---------------------€ .b _ _ _ _ __ ____ ________ _________ __________________________________________________________-_--___-_-_----_-___---_-___----___-- - ____-_-___-----______-_------_--_---__-___----.-..-.._-_-._--_-. I hereby certify that I have prepared this application and that the work will be one in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin,Local Health istrict, rl ' ----------- � Contractor) (Signed} - ---- - - ----- - - =F` (Title) = (Plot plan, showing size of lot, location of system in r ation to wells, build' gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ` } --------- ------- -------------- DATE '-f'�, ----------------------------------------- REVIEWEDBY------------------------- - ------------- - - ----------------------------------------- -------------------------------------• DATE------------------------------------------- --------------.. iBUILDING PERMIT ISSUED------•-----------------1— ------ � I �-------------------- DATE------------------------------ ------------------------------ r 1 a r. �J - � :7T Cot e°---------------------------- --------------•---------------------------- Alterations and/or recommendations:--.._-.--- --.�-- -- ------------------- ----- al"7 Date_-- - ----- ----- - -- ------- - .FINAL INSPECTION—BY:_.- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ! Stockton,California Lodi,California Manteca,California Tracy,California P F.P.CC7. y"