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FO�OFFICE USE: ------------------ --- APPLICATION FQR SANITATION PERMIT Permit No. ................,r___Z ----------------- ---------------------- -- (Complete in Duplicate) z Date Issued This Permit Expires 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. /32 -- cv_m— O� JOB ADDRESS AN LOCATION "f---------1r7 --------------------------------1------------------------------------------ D T Owner's Name------------ - --•--------------- - --------------------------- ----------------------------------------- Phone -� ------- Address.--- - J ------- -- - ---------------- -----------------------------------------• ---------------------------------•-------.------•---- ----------Contractor's Name_______ __ - PhoneGl Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer urt ❑ Motel ❑ Other Er- Number of living units: _--._-__ Number of bedrooms _______ Number of baths__-_ Lot size - --------------------------- Water Supply: Public system E] Community system ElPrivate [Depth to Water Table _ ft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe 2---H-ardpan ❑ Previous Application Made: (If yes,date---------------------) No ❑ New Construction: Yes Rr"No ❑ FHA/VA: Yes ❑ No ❑ ►. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Q �• �- Septic Tank: Distance from nearest well__ ----- ----Distance from foundation---/-_ -6 __-_.____.__Material.? --------------------- ---. i No. of compartments-----3-------------------Size11-��X—`X__/1_',---Liquid depth--- --f --------------Capacity__a_'�__a_a- .'` � ' Disposal Fidld: Distance from nearest welL_________________Distance from foundation--------------------D.is#ance, o nearest lot line________-___--__- ne of ❑ ypebof filter material--------------------------Depth off flterlmlaterial____.________...__..__Total hlegfh french ---------------------------- x _ � A Seepage Pit: Distance to nearest well---------------------- from foundation---,--------------- to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------,---------------:Depth-------------------------------.- Cesspool: Distance from nearest well-----------------Distance from foundation------------------ material__._...._.__.____-.______________ ❑ Size: Diameter--------------------- -------- -------Depth - --------0--Liquid Capacity----------------- ------.--gals. Privy: building r Distance from nearest well__________________.___...___.__-__._...__-_._...Distance from,nearest building---_.-._-._____.________-_______.____._- Distance to nearest lot line--------------- - ------- ------------------------------ ------ -------`--------------- Remodeling and/or repairing (clescribe):-___ � _ _._.__,_ --- ma' �-�.p- c'" -___�_�__ _____.-__� - ._------------ •---- ----------------•------------- ---------- -----------• , ---------------- ---- ---•- ------------ `------- -----------------------------------/ `� -- -------------------------------U__------- ----- ------------____`_____ __----------------------------------------------------------------------- - ------ -- _--- 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 regulations of the Sa Joaquin,Local Health-Distric+:` f (Signed)-------------------------- --- - ---- ----------- -------- ------ --------------------------- -.---(Owner and/or Contractor) By--- -------------- ------------------------------------------ J -�� ` ------- Title_-- ---------------------------------- (Plot -------- --- ---- ---- -- ------ 3 {I* { ) (Plot plan, showing size of lot, location of system in relation to well!/�iuildings, etc., can be placed o$�`reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY --------- -`---------- ------ -—----------------------------- DATE------- `l S ----- REVIEWED BY------ --------------- -- - ------ DATE------------- -------------------- BUILDING ------------ BUILDING PERMIT ISSUED------------------- ------------------------------------------- - DATE------------------ -------------------------------------- -- I Alterations and/or recommendations:-------------- ------ ---------------------------------------------------------------------------------- -------------------------------------------------- - 1 _____________________________.._______.._.__...__---_--._---___.._.--__-_..._.______._..________._.__-_-._-_._________-_________._-__.______-._._-_.__-_-_._.______..______.__-----_-__.--__________.._______________________- 4 __-__._____________________________________________________________________________________.___.______.__-.________.______________.____________-___-___---__-_--..__________._______----. -..__.__.____________- ...__...----------------------------------._......_____....__________--_____.......-.___._...._-._____._.____.___-...________...________..._.____...._..___-_...__-------_------------___-----.-_._________+_____-.._..._ FINAL INSPECTION BY:- .,.., --------- Date------..!' ,�.�.�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 285 West 91h Street -" Stockton,California Lodi,California Manteca,California Tracy,California t