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FOR OFFICE USE: , d ` 2-=---- .19_1 Aa........ ---------------------------------- -- ---- - APPLICATION FOR SANITATION PERMIT Yermit No. --------------------------------- ---- ------- -- (Complete in Duplicate) Date Issued ----------- This Permit Expires 1 Year From Date Issued Application is hereby made`to the tan 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 LOCATIO cel- ' Owner's Name-------------- -------------------------------------------------_ -------• -- ---�-=-�r -��--------- ------------- -------------------- --- -- -- - - Phone----------------------------------------- Address--------- &------,- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name---------�f 1.l��_�'7—------------------------------------------------ --------- Phone--------•-------------------------- t Installation will serve: Residence ®Apartment House ❑ Commercial' ❑, Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - _ Number of bedrooms _--_.,Number of baths . - Lot size _ e --------------------------- Water Supply: Public system TeCommun tyystm ElsePrivate`❑ "D'epth to Water Table :� ft. fa-� F Character of soil to a depth3 of 3 feet: Sandi❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe RT Hardpan ❑ Previous Application Made: Ilf.yes,do,teY______.S------- No &' New Construction: Yes ❑ No �r FHA/VA: Yes ❑ NoC�–� �.. I TYPE OF INSTALLATION AND SPECIFICATIONS: �\ No Septic tank or cesspool ,ermitted if public sewer is available within 200 feet.)---- I P P p �P ) Septic Tank: l Distance from nearest well-------..---_----Distance from foundation--------------------Material------------------------- .------ 4 ]I�7<(AV No, of compartments------f------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field:b Distance from nearest weii-----------------Distance from foundation--------------------Distance to nearest lot line_-_-__.-_--.--_ `f Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- Type of filter material---------------------- Depth of filter material----------------------Total length------------------------------------------ Seepage ---_.------ _-_-----__--__Seepage Pit: Distance to nearest well-----==77!-----Distance fr9p foundation---e!� ---.Distance to nearest lot line_/ -----_ Number of pits-_._4._-----.--Lining material_- _ Size: Didmeter__,,3 . _ .....Depth.�_r..sl-----.--_----._ ..«..._. ,..._ ,. -i 7 f Cesspool: Distance from nearest`well ________________Distance from foundation.---- .__..----._.Lining material-______.-.-__-________.__-___----._. ❑ Size: Diameter------------- -------- ----------Depth--------------------------------------------------Liquid Capacity------.--------- --------gals. t - Privy: Distance from nearest'yell-------------------------------.-----.__-.....:.Distance from nearest building______._-___----.-.-----_----.---------.-. ❑ Distance to nearest lot,line------------ -------- ----- -- ----------------------------------------------------- ---------------------------- Remodeling and/or repairing (describe)=-------- --. /f �---------------- a --- ------- ------------------------------------- •----- •--•--------------------------------------------------------------------------- ---------------------- ------------------------------------- � , ` l 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. Alp(Signed) _ �h' _ ��_. -_- _-._---_--____------- Contractor ,�qq ) I BY:---------------------------------------------- -- - ------------ (Title) ?Z4---------------------------------- (Plot •------ --- - ------------- --(Plot plan, showing size of lot, Iota o of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY r. -- ;_-- -------------------------------- -- - (APPLICATION ACCEPTED BY---------- =-- ------ �.:.��<-� ------- --- DATE-- - �--- -f--�_._...- --�� ---- - REVIEWEDBY----------------F- -------------------------`------'---------------------------------------------------------------------- DATE------------------------------ --- ------------------------` , BUILDINGPERMIT ISSUED-------------- ------------------------------------------------–-------------------------------------- DATE---- -- -------- ---------- ------------------------------ Alterations and/or recommendations:-----.------._ - ---------"- ------------ --------------------------•-------------------------------------------------------------------•-------------- - -----------------------------------•-- ------------ ------___-----------------------.------------------------------------------------------------------------------------------------------------------------------ ---- ----------------------------------------------------------------------------------------- ----------------------------------------- ------------------------------- ---------------•-------------------- --------------- 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 F.RC O. 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