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FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT Permit No. --------- ------------ -- --------- t ------ --------------------------------- (Complete in Duplicate) 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. rte Cc S —120 --!o _.------------------------------------------- ,,IONf JOB ADDRESS AND LOCA --__ . . _ ------------------------------- ---- --` ------------------ ----- Phone Owners Na -------- -- - - --•p-•---l-/--------------------- - _ Addressr� -------•-- ---------,--' l V- -------- --`-------------------------------•--•----- l s i Contractor's Name---- - j - --------2 ----------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/- Number of bedrooms ----/- Number of -a -.-- ths _- _- Lot size ..--..•----._._---- f.- Water Supply: Public system El Community system El Pi Depth to Water Table -------- ft. L/ Character of soil +a a depth of 3 feet: Sand ❑ Gravel p Sandy Loam ❑ Clay Loam ❑ Clay �obe F] Hardpan ❑ i Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes F] No ❑ FHA/VA: Yes ❑ No El N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . Septic ank: Distance from nearest well----- _--_.--Distance from�foun�fioh----.'F�_t�_.M''a``terial............. _..._. Q a No. of compartments --------Size_�. ..1. G P. '7" P Y...- I 47Q r Dispos Field: Qistance from nearest well- _....._Distance from foundat' j O Distance to nearest lot ` --------- Number of lines..............!�..- -_-p . . _Length of each line__....._....- Width of french-_._�__._...--___........-._. Type of filter material____..` i-J depth of filter materiaL...__� ��_..__-.Total length---_ ---------------•___-- � r r f Seepa Pit: Distance to clearest well--------1-vo- --Distance from foundation_.=._�a._..___.Distance to nearest IotSn�_.---5.-__.._ Number of pits.----------1--------Lining material, ..-k-.---.---Size: Diameter----- 3 . .---Depth---4--------------------- --- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_-_....--.-_-._--_- ❑ Size: Diameter-------------- ---------------- ----Depth----------------- ----------------------------------Liquid Capacity gals. ---------------------Distance from nearest building--------------------------- --------------- Privy: Distance from nearest well---------------------------- ❑ Distance to nearest lot line--------- ------- ---------- --------------------------------------------------------------------- # lRemodeling e airin descri ----- ----------------•------- -•------------------------- = I -- Y = I ------------ � 01 :.--�--- ------------------------------- -------------------------- ---------------------- - ------------------------------------------------------- -- -- - ----- -- - -------•---------------------------- ----------------------------- ------------------------- -------------------------- 1 hereby certify that I have prepared this application and that +he work will,be done in accordance with San Joaquin County ordinances, State laws, and rules ani; gulations of the San Joaquin Local-Health District. (Signed) ------------- - -------------- ----- --- -------- TI = _ ------------- -- ------ -------- BY------ Y --------- --f ------------------------------------------( (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED.BY ----------------------- --- DATE--�.l-._-�10 ----A0y = -- REVIEWEDBY-- ._'' -- ----------------- DATE--------------------•--------------------•------------------ 1 BUILDING PERMIT ISSUED------- ------------------------ -------------- -------------------------- -------------- ----._DATE_ - Alterations and/or recommenda#ions:.................... . ------------------ - --------------------- i -------------------------------•-------- --------- `r(4(tr . r �K..---------------------------------------------------------------- ------------------ -------------------------------------- ------------- ----- -------------------------------------------------------------------------------------------------------------- ------------------------•.____.....---_._._. I ` FINAL INSPECTION BY: /l _— ----------- Date--- ----------------------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street i Stockton,California Lodi,California Manteca,California Tracy,California F.F.CO.