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FOR OFFICE USE: 6 i ---------- --------- �0 �� APPLICATION FOR SANITATION PERMIT Permit No. . ..................... -- ----------- ------------------------= (Complete-in Duplicate) //`` I Date Issued ..?---.�___ 4gK ---------------------- ---------- This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinanc No. 549. JOB ADDRESS ANDCATION-_-1 ---aO..".__..- ;d-------------005��_ ----------------------------------------------- Owner's Name---------- - ------- -- ----- - - ------ Phone-------------------------='-----•--- Address-----------------1,7� -----•---- ----------------------------------------------------------•- ! Contractor's Name------..... �'------- - --- -------------- ------- ------------ Phone----....---- Installation will serve: Residence ❑ Apartment House ❑ Comrrlercial Trailer Court ❑ Motel ❑ Other;❑ r � -- . living units: -~_Number of bedrooms _ Number of baths-_ ot size _..__'__ ___________________ '._______..____...__.._ Number of i Water Supply: Public system ❑ Community system ElPrivate`�epth to Water Table ------ _ ft- Character t Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date � .." _.._.`:) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_:/-------------Distance from foundation--------------------Material ----------------------------------- ............ ❑ No. of compartments-------;-------------- -- Size--------------------- -----------Liquid depth--------- - ..... ........Capacity,-------- - ------------ D;sposal Field: Distance from nearest well.. _ ___Distance from foundation----ll?_.---------Distance to nearest lot'line-S_--__---_- Number of lines----------- I'/-_------------------Length of each line--------341�__..-------- --Width of trench...__Z. ._,_.--•----..--..------.- Type of filter materiel--.-- .-.1"�.- --- of filter material----1�y_ _..:'-----.Total length----,7.45----------------------------- 0 Seepa Pit: Distance to nearest well__ --_-..Distance from foundation------- a------Distance to nearest lot line---S.......... ' <„-, _,_.,_•,,,\.ONumber of.p! ----- ------ material Size: Diameter------q—1._...__.Depth....2 4_�---------------- 10 Cesspools' Distance from nearesf, ell ------_--”" Distance from foundation................. ..Lining material-------------------------------------- I ter -- ❑ Size: Diameter- .. -------- ------ ---- Depth_- ---------------------------- ---.--- -------- Liquid Capacity------------ - ------------.gals: sPrivy: Distarice4F•om nearest well.............................:....... .........Distance from nearest building._--.-__----_------_-_------_----..-_----. ❑ Distance to nearest lot line-------- ------------ ---------- -------------------------------------- ---------------------------------- Remodeling and/or-repairing (describe):------.-- --- ----- -- . --------------------- ----- --_ --------- - -----.. -- ---- -- -------- --------------------------- -------------------------------------------------- --------------------------------------------------------------------------------------------------- ----- ---------- ------ - -- - I hereby certify that I - e prepared this application and that the work will be done in accordance with San Joaquin County ' odinancesi-State laws;�a ;rules and regulations of the San Joaquin Local Health District. (Signed)--------------- ----- ----0.- - - nd/or Contractor) - - Title - ........ ........ ..................... .Br• f ) r (Plot plan, showing size of lot, location of system in relation tow s, buildings, etc., can be placed on reverse side). + r: FOR DEPARTMENT USE ONLY I A ' APPLICATION ACCEPTED BY---,I z'i. z .......... - DATE ' --(� -------------------------------- REVIEWED ------------------------- - REVIEWEDBY---------------------------------- - - -_----- ------------ ---------------------------------------------- DATE------ ------------------- BUILDING PERMIT ISSUED-------- -------------------------------------------------------------- ---------------------------- DATE---------------------------- - --------- IAlterations and/or recommendations:.------ -- ------- ------------------------- ---------__------------- ---I-------------------- ---------------------- ----------------------------- 1 -.---------------------------- --- ------ ---------- - ---------__,----------------------------------------- --------- --------------------------- •------ _____________________-.--..__-__---...----------`---------.._._.--_---`---------`------...._---------"---------`-----...----`-----------•--..._.---------------------.._......__'-------..._._---------------- �. ---------------------- ----- -_.------------------ .._._.-_...._.-----._....-..--.._ ----------------- -_-- ------ _.._ FINAL INSPECTION BY: - -------....._ ------------------- Date-. �---------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ltaxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguord Press