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FOR OFFICE USE: ---------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------ ----------- -------- ------------------ --------------------------- - (Complete in Duplicate) �� ._----------------- This Permit Expires 1 Year From Date Issued Date Issued ._______ ________ "�S Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descr ed This application is made in compliance with County Ordinance No. 549. / �..��p �� �j r JOB ADDRESS A LOC TON---G _�`_e - - r Q�.�f.-- A'Zl Owner's Name �1 1Phone------------------------------------ A---------------------------------------------------------------------------- Address Contractor's Name ,;.!?_4V_ � --°_'f��.t_-�-� .�L t - -------------------- ---------------- Phone-_446-7n.31 � Installation will serve: Residence [Apartment House E] Commercial E] Trailer Court ❑ Motel E] Other ❑ Number of living units: __1----- Number of bedrooms t3_- mber of baths -_� Q � � -� ---- _ -- --- ------------------------------ Water Supply: Public system C] Community system riLot size vate ❑ Depth to ater Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ dobe❑ 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 pub i sewer is available within 200 feet.) Distance from oun ti f Septic T Distance from nearest ell- ------------ e v--!"�--.-.-.-..M�atg r�F�_.. No. of compartments_-- - Size .. __ - i�Liquid de�th___ __b...............Capacifiy__ Disposal Fi Distance from nearest well. . _ - Distance from foundation---l--�---_..__Distance to nearest lot I•ne_-_ Number of lines-_. -__- f.----Length of each line-- '�/___ /__..Width of trench-_-,J_-f�___�__r f Type of filter material +� S_.__Depth of filter mater al____._ "--.__._Total length______________________�7__o?_____".-._ 1 l � Seepage Pit: Distance to nearest well_______---------------Distance from foundation-"---------------"-.Distance to nearest lot line--..--..--_____.. � El Number of pits----------------------Lining material--------..-------------Size: Diameter.------------.. .......Depth---------------__-------------V Cesspool: Distance from nearest well---------------"-Distance from foundation_____.--------------Lining material---------------.._..._-._."-"-.--_..- ❑ Size: Diameter- - -------- -------------------------Depth---- -----------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well ------------------------------------------Distance from nearest building_--.".--------------.-_------_----_-__._. ❑ Distance to nearest lot line---------------------------------- ------------ -------------------------------------------------------------------------- ----------------- Remodeling and/or repairing (describe):-------------------------- ------ ----------------------N------------------------------------------------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- - -------------------- ------------------------------------------------------------------------------v--------------------------------------------------------------------- ------------- ------------ I hereby certify fhaf-L have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, Airules and regulations of the San Joaquin Local Health District. (Signed) __ N '__8l� ----------------plls, bui (�weF..andfer' Contractor) - --------------------------------------------- - 2915 E Miner Ave., HO 6 3841 Title ___________________--_. _. (Plot plan, showing size of lot, location of system in relation toding etc., can be placed on reverse sick). FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- r ---------------- -- ---------------------------- REVIEWED BY--------------------------------- - ------------ -------- -- - ------------------------------ ---------------------------------------- DATE------------------------------------------------------------ - - BUILDING PERMITISSUED----------------------------------------------------------- ----------------------- ----------------- DATE------------------------------------ ------------------------ Alterationsand/or recommendations:--------------- ------------------ --- --- ---- --------------------------------------------------------------------------------------------------------------- -------------------------------------- - ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ ----------- ------------- ---------------------------------------------- ---------------- -- -- ---------------------- ------------------ - --------------------------------------------------- ------•--------------•--•-------- /1411 1 FINAL INSPECTION BY:__„ .� - _________________ Date:+-'-- �1 - -------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C❑.