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FOR OFFICE USE: r ------------------------- ------------------------------- - -------------------------------------------------------- APPLICATION FOR SANITATION'PERMIT Permit No. _ .i1.1.....�... (Complete to Duplicate) ----------------------------------- --------------- - _-. This Permit Expires 1'Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her n describgd. ; t This application is made in compliance with County Ordinance No. 549. r �Q i r JOB ADDRESS AND LOCATION---- ------- Y�----------Rtl---- -`"- Owners Name 7 Fe 7 - 4-1?-- ------------------------- Address-_ e_I 171 R Phone----- ----- r - � - ----------------- Address.. .....--SRT--1--------&4 ,3- -- --Af�1-A---------- -------------------------------------------•----------------------------------.---- Contractor's Name----------- --••------------------------------------------ -- -----------------=-------------------•--..-- Phone----------------------------------- + Installation will serve: Residence [ki Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [_I Number of living units: J.... Number of bedrooms Number of baths ---- Lot size ---------Re.s�_?"_�__._____________________ R Water Supply: Public system E] Community system F1 private P Depth to Water Table _,f0_ ft. Character of soil to a depth of 3 feet: Sand 0' Gravel ❑ Sandy Loam L] Ciay Loam ❑ Clay ❑ Adobe E] Hardpan ❑� Previous Application Made: (If yes,date--------------- ---) No ©- New Construction: Yes ❑ No 0^ FHA/VA: Yes ❑ No [r - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or.cesspool.-permittedJf'public.sewer.:is available within.:200 feet.).-..,.,zv, Septic Tank: Distance from nearest well____ Vis____-__Distance from foundation_____--_________.Material___��_--- .r'_ ------------ [�- No. of compartments------� S..f ----------------Size._ __�C_:fi< _ .1 ------9--_. ,---L+quid depth --------------Capauty-.I_----•6 -- ;- Disposal Field: Distance from nearest well.-_5.!:,-_`---Distance from foundation.--f_�'-_____.__Distance to nearest lot i Number of lines----------f,_--------------------Length of each line------ -a_ --------------Width of trench_---_4n- ---_------------__-_-- Type of filter material-----to?_tis_f__ft....Depth of filter material____Z4'_1. .....Total length------ _f? ___- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-_-_--------_____ ❑ Number of pits----------------------Lining material--------.--------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well__.___________-Distance from foundation-_•-----------------Lining material------------------------------------ ❑ Size: Diameter---------------------- - --- Depth----------- --- ------------------------------------Liquid Capacity----------------------------gal` Privy: Distancerom nearest weii----------------------------------------_ g--------- -- --------------------- t _-..-._Distance from neatest building ____. [] Distance to nearest lot line--------------------------------------------------------------------- ------------------------------------------------------.--------------= ( Remodeling and/or repairing (describe):----------------------------------- --------------------------------------•-------------- 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. (Signed)------ —,TiM 'N-' -----_--------------- - ---Owner and/or Contractor -- �--------�--------_--- --------------------------------------. ---- ----F_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 APPLICATION ACCEPTED BY--- ------------------ ------- --------- ------ DATE- ------ ------==---------- REVIEWEDBY----------------------------------------- - - ------------------------------------ ---- -------------------------------------- DATE-------------- ------------------ --• ` ----------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ----------------- DATE--------------------------- ------------- - -------------- -- Alterations and/or recommendations:----------------------:-------------- --- -----------------------------• •----------------------------------------------------------------------------------- -•-------- --------------------•------------------------------------------- ------------------------------------------------------------------------ -•---•---------------------------------------------{`------------ --------------------------------------------- --- - -------------------------- -- ----------------- --------- ------------------- ------------------------- - --- -- -- i ---------------------------- ----- ---- -- - - ti FINAL INSPECT ------- Date----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1601 E.tfazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stocktonr California Lodi, California Manteca,California Tracy,California F.P.CO. .