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FOR.OFFICE USE: ----------------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No.'_ --------------------------- ----------------------- --- -- - (Complete in Duplicate) -� Date Issued ---------------------------- _-- This Permit Expires 1 YearFrom 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 Count Ordinance o. 549. J h1 ' rr ?- 2S 3 y /f ��:�� r�..tee✓t�a�u,c."r �j� � !l' JOB ADDRESS AND LOCATION -- ---------------- ------------- ------------- Name_._ _. -- --- --------------------------------------- Phone_ -�-- ------------ Owner's Address f ----- �- --- '- ---- ----- ----- ------- // q� Contractor's Name------------- - ---- - --------- ---------- �"�"� +� C*� Phone�.G_#�_^_�� ------- - - ------------------------- - - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 9—. Number of living units: __I-- Number of bedrooms Number of baths ___I_ Lot size ___- ____-__________---------i'------------------ Water Supply: Public system ❑ Community system ❑ Private jt Depth to Water Table la_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan C] a Previous Application Made: [If yes,dote._.__,--------------I No 1' New Construction: YesW No ❑ FHA/VA: Yes ❑ No ❑ --TYPE0F-INSTALLATION-AN D-SPEC-IFIC WTIONS: - (No septic tank or cesspool:permitted if public sewer is available within 200 �) N Septic �: Distance from nearest well_....__ _Distance from foyndafion_ _____.__-___.-Material_ -------------- __________-.___.. Eel` No. of compartments__.____ Size__¢ SI4__Liquid depth____ ._______.____Capacity_o L Disposaeld: Distance from nearest well__ -------Distance from foundation--,e5?Z>_. .__-Distance to nearest lot lina:47t - Number of lines______________ _____Length of each line __-_ _ 5!-_-.Width of trench------- ___________ _____ Type of filter materiaLsr- j_tl-____Depth of filter material ._.l_8._"_____-_-.Total length________= -:------------- Seepage _ __Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__.__-______-__. ++ I� E] Number of pits----------------------Lining material------ --------------.Size: Diameter------------...--------Dept h--------------------------------- -'h Cesspool: Distance from.nearest well-----------------Distance from foundation___------_----------Lining material _._._.____--_-_____.______-_.-_.-__ Size:,Diameter ---------------------------- Privy: T -` - ❑ --_-,..De th- --w----�._-��- - ,_u_ = __.-.Li uitlrGa aci•t _=_�- ais �- Privy: Distance from ,nearest well-________________________________________________Distance from nearest building ❑ Distance to nearest lot line------------------------------ -- - -------- A- - — ----------------------------------- Remodeling - - . Remodeling and/or repairing (describe): ---�--- -------- ---- ------- __________------------------_________________ ____________________________________________ __ ____R__ ___ ________________________________________________________________________________-.__ - _ --------------------- ------------- --- - =------------------- ------ ----------------------------------------------------- --------------_: _:_----------------------------- ------- ------ --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and ruts and, re lations of the San Joaquin Local Health District. (Signed)-------- - - -- ,..--- ----- �r i ner and/or Contractor) _ -------------- - .. In showing sae of lot location of system m rela n to wells, buildings, a (Title]__ _ ____ ___ _____ __ __ ____)_-------------------- By: � (plot plan, g y g etc., can be pl ced on reverse side. FOR DEPARTMENT USE ONLY �I APPLICATION ACCEPTED BY....../K _1-,000i-5 _ ----------- DATE- � / ----------� REVIEWEDBY--------------------------------------------- ----- ---- ------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------- - -----------------. A E----------------------- Alterations and/or recommendations--------------------------------------- � - - - -•--- ---------•------ -------- ---- ------------ ------•------------------------------------- -------------- --------- ------------------- ------ - -- -----------•-------------------•--------------------------------------- ----------------------------------------------------------------------------------------------------- -. --------------------•-- -------------------------------------------- ----------------------------------------------------- ------------------------------------- - -- --- - - ------------------------- ---------------- --------------------------------------------- ------------------------------ C FINAL INSPECTION BY-- ----------- --------- Date---------.... `� T ` ----------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.R CC.