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FOR OFFICE USE: r- ---------- ------------------ ��' -------------------------------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. __ ________ ______ ------------------------ - --- - - -- (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. j.� ; 2�$�r,�55D �� -------- -----------------------------;-zip:c-.===-- JOB ADDRESS AND LOCATION - f....---=---•---', ----- ----- Phone --- J 1 , Owner's Name------- `�2t_t .-------- t�� ._:f` _`: ------- •---------------- T ``---- :. Phone._._.. Gf Address { Ul `�' ----------• t - .f._ _ j .._. ---- Contractor s Name ` F -r -�.L./ ----------------•----- Phone ---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.__-!___ Number of bedrooms __9. Number of baths _ Lot size _____. QJ C� __4 Water Supply: Public system ❑ ..Community system ❑ Private Zf Depth to-Water Table _?i--- ft. ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe, Hardpan C] J Previous Application Made: (If yes,date----------..........) No New Construction: Yes ©. No E] FHA/VA: Yes [:1No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----- .. '_--_Distant�from�f//o�rt ti _-___ __ •.._.Materflai_,____.��:-�- �_'` ..___.____.` n. No. of compartments_.___...` -_________ Size__'.----y _ -- quid depth--------�'!_---^-�--:Capaeity..._ _ Disposal Field: Distance from nearest well.___:.=` ..-Distance from foundation-- ----- _ ;Distance to nearest lot lige_ _->_-_..___-. � r p j Number of lines------- --------- .Length of each line/-�_f_ 7__ f�Width of trench....., i 7, �______--_..__________ Type of filter material__f�.Lj' epth of filter material____ _!_`-------Total,,length_____ ___.________`---------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------.-----------Distance to nearest lot line-------_-____..._ ❑ Number of p,ts----------------------Lining material------------------°___..Size: Diameter-----------------------Depth------------------------------------- a Cesspool: Distance from'nearest well-----------------Distance from foundation------------------..Lining material-_._-_______--.---____________-__-__. ❑ Size Diameter--------------- --------- ---- Depth---------:------ - --- ----.Liquid Capacity :— --gals. Privy: Distance from,nearest well-______ ___________ ___________ ___ _____-- istance,from,;nearer+.building__________•__-_. --------------- ------ ❑ Distance to nearest lot line------------- ------------------------------ ---------------- -A--------------------------------------------------------------------- Remodeling and/or repairing (describe)--------- ------ --------- } -------------- ---_ i ---- . r __________________________________________________________________ ___•__.________-____---__.__-_-_______________.,_____._____-___.____._______._____.____.___.____.___-_ _.------ ---------------------------------------- , . _I. ------------------------------------------I------------1-------------------- . -------.------------------------------------------------------__----------------------------------------, 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. Si ned /+ ----------------------(Owner and/or Contractor) By------------------------------------------------------•------------------------ -----------------------------------------------------(Title)------------------------------ ------------- --..-------- (Plot plan, showing size of lot, location of system in relation to wells,,buildings, etc.;.,can,be'.placed,on.reverse side).... FOR DEPARTMENT USE ONLY APPLCATION ----------------------- ---------------------------Fz_4 - ATE f ... z_ REVIEIW ED BY- ACCEPTED BY : - ---- - --- --- DATE--- `�� BUILDINGPERMIT ISSUED------ --------------------------- ------------- ---•-- DATE----------------------------------------- ------------------- Alterations -- -Alterations and/or recommendations---------------------------------------------- ----------•------------------------------•--------•--•--------------•---------------------------------------- ---------- _______________________________________________________________________________________________5..-_______-___________-_----F___________-_____________--_-_______._.___-_____-_____-_.-..--.-.----.---...____-____._.___-.-.__ ---------------------------------______________________________________ _ _`_ -.---.-__ ._._____._____.._---____.__..__----__.________..___ ___._-_-__-. _ ._...-_-------______________ _._- . ...-- -.f _ _ ___ }sem FINAL INSPECTION BY: = - Date----------- --- - ----------- ----------- - ----------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 3M 3•'63 F.Fk=