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FOR OFFICE USE: ��0-------- -------------------- f- APPLICATION FOR SANITATION PERMIT Permit No. ._a�:� f• ------------- ---------------------------- ---- ------ (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 OC ION-_- ' + ____.. I ` �,�((// � ! ---• ------------------------------------------------ Owner's Name--------- .l�K - - -----, ,�- f_- --�-----._._. Phone Address------------•---- --- _� `- =E '=-=----------------------------------------------•--------.-- 4 Contractor's Name---------------------------- .�/ "9 =11%0 ✓c --------------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/._ Number of bedrooms _A' Number of baths Z�__ Lot size tr _ {.- ____________----------------- Water Supply: Public system [jr}__*�Fommunity system ❑ Private ❑ Depth to Water Table _44 f+ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff'-0-ardpan ❑ Previous Application Made: {lf yes,date---.---.------......) No New Construction: Yes ❑ No pa--_MA/VA: Yes ❑ No P— TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic TaEik:- Distance from nearest well_____________'="Distance from foundation------------------- Material____._.__..._____________________.._______.__. No. of compartments------------ --Size--- --------------------------Liquid depth--------------------------Capacity-------------- -------- Disposal Field: Distance from nearest well--_- _ _ _'Distance,from foundation_ _I P--------Distance to nearest lot line_� -------- ®r Number of lines__________...�` zzJJ Length of each line_ __ --- -_-._.Width of trench_2------------ -__-._ s Type of filter material Dept h of filter pp1Total length_ '__________________________ --- i Seepage Pit: Distance to nearest well_____ .._Distance from. foundation--_.A -------Distance to nearest lot line__--------- [� � ' Number of pits______ ____________Liming material__ 0'.'0 _..-Size: Diameter_ �p._-_-___Depth_.Z -------------------- Cesspool- Distance from nearest well----------------Distance from foundation--------------------Lining material_____________________________________ ❑ Size: Diameter------- -------------- ---------------Depth-------- ---- -------------------R---------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well .__.__---------_----------------_---------_____Distance from nearest building-_--,,..__-_______________________.______- ❑ Distance to nearest lot lire- --- - ------------------------------------------------------------------------------------------------------------------------------------ r Remodeling and/or repairing (describe)--------- ------ -------------------------------- --------------------------- - ------------------------------------------------------------------------------------- --------------- d% ------------------------------------ -----------------------------------------------------------------------------------------------------=----------------------------------------------------------------------------------- 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 rules and regulations of th San Joaquin Local Health District. - F (Signed) -- ------'-- � � ` � ( wsl Contractor) By:------------------------------------------------- -------------------------------- - ----------{Ti+le) ��r�/2 -- ------ (Plot plan, showing size of lot, location of system in relaf to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- --- - -- ------------I- -- ----------------------------------------- DATE------- - � --------- REVIEWEDBY------------------------------------------- ----------------- ---------------------------------------------------------- DATE----------------- ------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE---------------------------------- ------------------------•- Alterationsand/or r co mendations----------- ----------- ---- ------------------------------------------------•-----------------------•---------------•--------------------------------------- 517— -- -- � - - ------.....z r -------------------------------------------- --------- --- ------------------------------------------------------- --------------- ---- ------------------------------------..__..---------------------- -------------------------------------------------------------------------------___--__...______._r--___________.--------------------------------------------- i ice. FINAL INSPECTION BY:------- fes --------------- --- - Date -' - - -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.cn. a' f