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_. _. FOR OFFICE USE: ' ------------------------------------------ ------- ----- APPLICATION FOR SANITATION PERMIT Permit No. .11.a --------------- (Complete in Duplicate) ------------------------------------------ This Permit Expires 1 Year From Date 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 with County Ordinan�ef'o. 549. s !/ .�, `ao Ori r'�` n� JOB ADDRESS AND LOCATION i---r-'-- Owner's Name Jt`1 ----e--- ' � Ci j TD---------- --------------------------- -------- Phone------------------------------------- Address-------------------------------------------- � V-, _ ©t &t,) T d -- Contractor's Name----------- . = �"r/ ' ? Installation will serve: Residence aApartment House❑ Commercial "❑ Trailer Court I Motel ❑ Other ❑ Number of living units: -.. __ Number of bedrooms __I_ Number of baths __/-_. Lot size ----------------------- Wafer Supply: Public system ❑ Community system ❑ Private ❑Depth to Water Table -------- if, ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel [5 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-.------------------J, NoXL New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No,® TYPE OF INSTALLATION AND SPECIFICATIONS' + .r (No septic Tank or cesspool permitted if, u-ltc se er available within 200 feet.) Septic Tank: Distance from nearest SII-;•-.- ------ -isance from foundation---Z�-_�_- Material--_ No. of compartments...--. __ _ �!ze_ lsz -_: Liquiddepth_-- `r--.-___Capacity. .g Disposal field: Distance from nearest IL... _ -_.____Distance from foundation--, ./ 1i to nearest lot line-�e'!Z Number of lines.__....___ _----_- Length of each line__ :�1 _=. -5_..Width of trench---%�$ `r------------------ Type of filter material___a/ �i --Depth of filter material --/___-e-`......Total length---V.2:p------------......:.... Seepage Pit: Distance to nearest well----------------------Distance from foundation---- ------------Distance to nearest lot line_..._..........- ❑ Number of pits------------------ --Lining material----------------------.Size: Diameter-----------------------Depth_------------------•-------------- �' Cesspool: Distance from nearest well-----------------Distance from foundation._ ----_-_--------_.Lining material----------- .___..-----------. +, ❑ y Size: Diameter_ ---------------------- Depth-----. . _-. -------------------------------- Ca acitY ----=-------------------..gals. D�stancefro Privy: Distance to m nearel t line- --- _. --� y----------------------------- ---t-- -� ------------#-Distance from nearest building__I-.:.---______..._________.._..__..._. ❑ - ------------ •---------- ----- S* Remodeling and/or repairing (describe):_____.._ 2 ' ------- •,_________•_�__- _-_------- f ) .# { � '/ -------- -------------------------------------- --------------------------------------------�--- Y Y prepared PP ' h -wo -♦ �� [ � I hereb cer}if that I have re ared +his a lication'and that the wo k will`be done m________________ accordance with San-Joaquin County ordinances, Sfafe laws; nd rojfT,.and regulation Df.th San Joatquin-L1acal Health District' (Signed)- - - - / r r --�•-- --------- - ---�,- - -----sem-- - - 4--�'- -------=- -:- weer and o- Cont actor) By:- �2= —��"-c-- i•! ., (Title) h -' ------- ------ f------- Plot Ian, showing size of lot, location s stem i Tela+ion +o wells, bui� " " ---. ....- [ p g y Idingf" etccan be placed on reverse side). FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY----- ------- --- - ------------ -- ----------------- ---------------------------------------- DATE------------------- - - - REVIEWEDBY--------------------------------------- -----I---------------------------------- ---------------------- ------ DATE------ --------------- BUILDING -----------•BUILDING PERMITISSUED--------------------------------------------------------------------------- ------ DATE---------------------- '- ------------------------------ I Altera+ions and/or recommendations:----------------------- - ------_----------------------------------------------------------------------- ----- -------------- ----------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ••- ------------- ------------------------ -------------- --------------------------------------------------- ------------------------------- FINAL INSPECTION BY% i;� Date-- ----- f� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West oak Street 124 Sycamore Street 205 West 9Th Street ,may Stockton,California Lodi,California Manteca,California Tracy,California