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FOR OFFICE USE: ------------------- ------------- -- -------------- APPLICATION FOR SANITATION PERMIT Permit No. ----- ---------------- ------------------ ------------ ------------------ ---------------I---- ------ (Complete in Duplicate) Date Issued ---------------------------- ---------- This Permit Expires 1 Year From Date Issued Application tion 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. d(03— too —11 VJOB ADDRESS AN 0 tfe---X --------- Owner's Name-------- - --- --•---- -------------- ------------------I---- --------------------------------- Phone------------------------------------ _�k r�L -- --------------------------------- Address ------------------------------_--------------_--------------------- ---- Contractor's Name------------ ----------------------------------------- ------------------------------------- ------ Phone--- •••--- Installation will serve: Residence E] Apartment House El Commercial 0 Trailer Court [] Motel Number of living units: A/_ Number of bedrooms /0 Number of baths Lot size ----=------------------------ Water Supply: Pub.lic system E] Community system C3 Private U;,<epth to Water Table a4ff" Character of soil to a depth of 3 fee+: Sand 0 Gravel 0 Sandy Loam El Clay Loam [I Clay ❑ Adobe @?"Ho`ardpan.0:, Previous Application Made: (If yes,dote----------- No gRI, New Construction- Yes ga, No [:] FHA/VA: Yes Z4-"-No C1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-permitted;if public-sewer is available-within 200 feet.) A.- Mate Septic Tank: Distance from nearest well____Xo�----Distance from foundawon--- ---------------- No. of compartments-_.__`y-- - ---- :n_�V -------------- 9910" ents------ly_- e-4,1^iquid dep*_-4_'_" Capaci Disposal Field: Distance from near we1__4__P_j_Distance from foundation_._1_29. -_-Distance to nearest lot iine-47 Number of lines--- 0. Length of each W, -----Width of trench_ --- ----------------------- --Depth of 19 -------------------------- e filter material...XIJ--- L Type of filter material Total length Seepage Pit; Distance to nearest well--- Distance fj,9m foundaflon__/1e----------Distance to nearest lot li j I - 9?101- Number of p:ts------?-----------Lining material__,,*KCe __ Size: Diameter.-,_7S----------Dept h_a-5---- Cesspool: Distance from nearest well-----------------Distance from foundation.._.__-___.-----_. Lining material--r------------- ---------------- El Size: Diameter------ -------------------------------Depth--------------- -------------------- - -- ----------Liquid Capacity---------------------------gals. Privy: Distance from nearest well---------------------------------------- -----Distance from. n"resf building---------------____________-.._-..------. --------------------------------r--------------------------- Distance to nearestdof line----------------------------------------------------------------------- Remodeling and/or repa'iring (describe):-----------4-Z!7�- ------4-IZ4� ---------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- - ----------------------------------------------- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ X 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 re ulatiori the S n Joaquin Local Health District, ....... .......... .... .. ------------------------------------- m&-&ad4w Contractor) -----77;oAe (Signed)------------------------------------ It— _-_-___ _ _ ;o ---- ----__ ------------- ------------------------------------------------------------ w (Plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- ------------ ---------------------------------------------------------------------- DATE-------------------------- ------ -------- ----------------- �EVIEWED BY----- ------------------------------------------- -------------------------------- ------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------- ------------------------------ 'Alterations and/or recommendations:--- ------------------------------------------------- -------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- - - -------------------------I------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- ------------------------------------------ ---------- -------------------------------- ------ -------- -------------------- ------------------------------------------------------------------------------- -------------------------------------------------------------- ------------------ - ----------------------- - ------------------------------------------------------------------------------I-------------- --------------- ------------------------------- ---------------- FINAL INSPECTION BY:_.. xc,�V�----_----------------- Date -------------- -------------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F,R Ca.