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FOR OFFICE USE; :— _.--. APPLICATION FOR SANITATION PERMIT Permit No. _ .. � ----------------- ----------------- ___._...__.___-._.. ompete inDuplicate) This Permit Expires 1 Year FroinDate Issued 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 wifh-County-Ordinance Na. 549. JOB ADDRESS A, LOCATIO _.__ __l __ __ . __ _ ____ ----- ---------------------------------------- Owner's Name ---- - -------- ---- Acldress_,"2. ,kFQ ; ------------------------------------------------------------------------------ - ---------------------------.-------- Contractor's Name-------------- "' f r -------= ---_-----•---•- ---------- ---- - -- ----------=----------------------------------------- ------ Phone_-------------------------------- _•` Installation will serve: Residence Ejl� Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other E]Number of livingunits: -------- Number of bedrooms _ __ ._ Number of baths _ __.._ Lot size ___-- _ -��,. . .- Water Supply: Public system Community system Pateriv _ . De th to Water Table -------- ft. Character of soil to a depth of 3 feet:` Sand ❑ Gravel ❑ Sanely Loam ❑ Clay Loam ❑ Clay [I Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date - >t-�4_�} 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 e pt �Tank: � Distance from nearest well __-Distance,from.fYoun1dation--------------------Mr ,rr aterial.-'__________________ __ ------------------ No. __ �__:--. No. of compartments.__ size---------------- -- Liquid de th -._ -------_.-Capacity-------------- Disposal Field: Distance from nearest well-- W—Distance from'foundation__ �O `"Distance to nearest lot line-_-_--.�_ Number of lines------------ ____---------Length o,� each"lrne �__ ��:-.Width of trench------,��-------------------- Type -(_ ____________ T e of filter material____._ 6� t_De th of filter material ry n _Total len fh 6 0 SeepaLw,Pit: Distance to nearest well----------------------Distance from'"foundation`)_-_---: `•_:Distance fo nearest lot line_---------..----_ Number of pits.......`--------------Lining material------------ -=-----Size: Diameter_'_-----•-----------------Depth---------------------------------- Cesspool: ------- ---------------------Cesspool: Distance from nearest well----------- Distance from foundation-- -- -------$__lining material----------- 'k ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Li quid Capacity------------------- apacitY------------------ --- ----gals. I Privy: Distance from nearest well--------------------------------_----------------Distance from nearest building---------_------ _--------------- ❑ Distance to nearestlot line_..._-.--- ....__.... ` --------=------------------------------------------------------------ -- --- - - - ----------------------•--•---•--------- 1 Remodeling and/or repairing (describe):--------- �+�t=0s-----�°------- �A�111A ------- 4�_ 1- ' ----------------------------- -----------------•-••--•---------------------------------------------------------------------•----------•--------- -------------------------- - I.?F' -------- ----------- --- --------------- --------------------- W. 1� ----------------------------------------------------------------•----------------------------------------------------------------------------------------.;-=;--------- --------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancesV:�.Iaws, and rule and regulations of the San Joaquin Local Health District: (Signed)-- • - - - - - !-------- ------------- ------------ --------(Owner and/or Contractor) By:-------------------------------------------- ------- Y= ' ----------------------------'.;------- ------=4------- --- (Title]---------------------------- -----------"----- ------ ----- P f 9 Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be`placed on reverse side). c a c R EPARTMENT USE ONLY N APPLICATION ACCEPTED BY----- ----- DATE-------- __"3_7Z,Z------------------- -- - REVIEWED BY - - - -- ------- --- DATE �BIJJLDING PERMIT ISSUED- ----......... %!-------------------------------------- -------------------------. -----------._._ DATE--------------------------------- ------------------------- Alter-atiq!n! and/or recommendations;------------ ----------------------------------------------------------------------------------------------------------------------------------------•-------- --------------------------------------------------�--------- ----- ----------------------------------------- ---------------------------------------------------------------------------- --------------------------------------------------- ------------I - - - • --- - -- --------------------------------------------------------------------------------------------------------------------- --------------------- 4 ---------------------------------- --- - - - ------ - ----- ----------------...------------------------------------------------------------------ ----------- ---------------------------------------------------- -- FINAL INSPECTION BY:.--------C. --------------------------- ------------- Date- ---------------------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ir Stockton,California Lodi,California Manteca,California Tracy,California ,. C.P.C 0. � ��