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A� - ' _____-.._._: APPLICATION FOR SANITATION PERMIT Permit No. (Complete implicate) / ------- --�--�-=-------- ------- ---�--- ------- --- This Permit Expires 1 Year From Date Issued Date Issued ____ --------- Application --_____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 AND LOCATION..__ 0 ..._ �,, --- - - - -- ----------------------------------------------------------------------- Owner's Name_ Address------ ------------- Phone------------------------------------- -- --------•--•--•-- ----------------------------- Contractor's Name. - ----- -------- Phone.................. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: _/___ Number of bedrooms -*'Z-- Number of baths -_,/__ Lot size .04._---- Water Supply: Public system [Community system ❑ Private [❑ Depth to Water Tablet r. ` Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobelG--nardpan ❑ x" Previous Application Made: [If yes,date____________________) No J��New Construction: Yes ❑ No•94--FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__".__------Distance from-foundation__ ,/�, ateriaL_. .----------- ®� No. of compartments_._ ._____.__..--_,Size _X- 3 Liquid depth �� Capacity---� .-_: Disposal Field: Distance from nearest well__--�--------Distance from foundatio ..___ � /f�._.__,_-.Distance to nearest lot line___a�__�___._____ ®� Number of lines________ __________ ength of each line--- Width of trench._- --_-_._.- -- i 1 Type of fitter material_- epth of filter material-•- 7f/ Total len th____ 1" ---------- g ' Seepage Pit: Distance to nearest well-____--""_____Distance fr m fo ndation-----��.__.Distance to nearestrhot line-4��•---- d Number of pits____ ____________Lining material___'A Size: Diameter.__ i_.__---Depth__v�c Cesspool: Distance. from nearest well-----------------Distance from foundation___________________Lining material-------------- .___- - ------------- ❑ Size: Diameter------- --------------- --------------Depth------------------•---------------------------------Liquid Capacity----------------------------gals. 'r Privy:. Distance from nearest well________________________ ------------------------Distance from nearest building-_-------------------------------------- ❑ Distance to nearest lot line ------- - -- - -------------------- -------- -------- ---------------- Remodeling and/or repairing (describe)______________ -- ------------------•-•----------------------- a ---------- 4----------------•------•------ EG ------------------------- ---------------------------------------- • --------------•-------------------------•----•--- --------I.,- - - --- - ------- 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 the San Joaquin Local Health District. t (Signed) -- - - --------(�or Contractor) By:------------------------------------------- ,-1 ------------------- (Title)--&*------------- -- -- -------- -- Pot plan, showing size of lot.,location of system.in at to wells, buildings, etc., can be placed on reverse side). t , - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- 1------- --- -- ----- --_------------------------------------------------------------- DATE - ---1 REVIEWED BY--------- -------------------------------- - BUILDING PERMIT ISSUED-------------------------- - ------ ------------ --------------------- DATE--------- - ----------- -- --------------Aiterati0ns and/or recomme ations:_____ _________ �"-cf —�' ': �t C- � ]" - r^t ----------- --------------------------- G FINAL INSPECTION BY:......... ...... Date_.... /,? SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californla Lodi,California Manteca,California Tracy,California £5 9 REVI6EO B-59 3M 3-'r.3 F.p•CO.