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y { FOR OFFICE USE: ___-_--__-___-_---._S,,---_.-. APPLICATION FOR SANITATION PERMIT Permit No. _ 1� 3� z ------------------------------------ (Complete`.n Duplicate) Date Issued < ,��-This Permit Ex fires 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 AND LOCATION- + - -a t ----- Owner's Name--------- ---------- ------ ---. Phone -44s-_V.�'..3 Address------------------------- " ------------------------------------------•-----------•---------------- - -- -- ---------------------- Contractor's Name-----------------------a _ �jY '"------------------------------------------ -- -------------------------------------------- Phone----------------------------------- Installation will.serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ el ❑ Other ❑ Number of living units: ---!_-_ Number of bedrooms'*_ Number of baths Lot size --------__ -¢---------------.___.------- __._ r Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table JQ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [-❑ Clay Loam ;lay ❑. Adobe 9<ardpan ❑ I Previous Application Made: (If yes,date............. ....) No New Construction: Yes 94N, ❑ FHA/VA: Yes ❑ No ®-- --- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well------------- Distance from foundation--------------------Material-------_------_------ ._____________--....___--- /h No. of compartments--------------------------Size--------------------------------Liquid dep;th---- ---------------------Capacity------ -------------- Disposal Field: Distance from nearest well----- ._*Distance from foundation__- Q_ Distance to nearest lot line------ [ /� Number of lines_____________ �.. --------- _Length of each line_____iY _04)-_--._.Width of trench._.__ _._ Type of filter mater:a _ P. Depth of filter materiaL__.__ �r Tatal leng#h__________ f 0 1 ` S SeepagyY Pit: Distance.Jo nearest we I____ ---------------Distance from on--- Distance to nearest lot line__.._..._..._-- ! 1� Nurnb�r.of pits----A____--_-----Lining materiai__A_4�k_____Size: Diameter__--�---_.-.-_Depth_..._t 'c `______ ________ Cesspool: Distance from'nEakest well-----------------Distance from foundation---.---__.__..._..Lining material_____--____--._____._____-.-__------ ❑ Size: Diameter------ '_.----ti-------------------Depth------------------------------- - - -- ----- Liquid Capacity---------------------------gals. Privy: DiOance from nearest well_________________________________________________Distance from nearest building-----___--.______.__---____.__..___--- ❑ Distance to nearest lot line=,'- --- ---------- ------ -----------=--------------------------------------------------- ---------------------------------------------- k � Remodelingand/or repairing (describe) '--------------- --------- -------------------------------------------------•-•----------•------------------------------------._.-................ --------------------------------------------------------------- ----------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. C�ii --------fit-------- ! (Signed) ------------------------------------------ (Owner and/or Contractor) 1 By:------------------------------------------------------------------ ------------------------- ------- -------------(Title)---------- -------------- -------------- IIJJ (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 APPLICATION ACCEPTED BY---- - DATE CT _ �' .. ------------------ ---------------------- REVIEWEDBY----- ------------- ----------------------------------------------------------------- -------------------------------------- DATE----------------------------------- BUILDING PERMIT ISSUED---------______________________ -------- __`__ _ DA E__ __ ---- Alteration and or recommendations: ------� _ __, - ' -s--- � �^+ t----- -- - ----------- - ------------------------------------ -------------------------------------------- --------"--•--------•-------------------------------------- ---•----------------------------------------------------------------------- -------------------------- --------------------------------------------------------- ----------------------------------- --- ------------- - -------------------------------------------- ---------------------------------------------- FINAL INSPECTION BY-------------- Date- - - ------------------. SAN ( JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CC.