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�J� . F OFFICE USE.. :�s - 4e ,4Z '�--------------------------� APPLICATION FOR SANITATION PERMIT Permit No. ..,-_ -:- ��--- ---------------- ------------ _------------------------ (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 instalt the work herein described. This application is made in compliance with County Ordinance No. 549, ` -�/- ------ lE' ----- JOB ADDRESS AND LOCATION--------------- - -�-- --------- -- -. � - ------- -------------------- Owner's Name----------------(11 A / �-0---------------- ------------------- Phone -�`� --V'3 ---------------------- ? - a-/, ----------0�----------------------------------------------------------------------------------------------------- AddressContractor's Name /� ---------------- Phonet �R'-- _7 - -1 --1-s- - . ter' Installation will serve: Residence Department House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms --,,Z-- Number of baths _-I_.- Lot size -------- -------------- Water Supply: Public system ❑ Community system ❑ Private [,Depth to Water Table *__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ -Clay Loam 2--Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 21 - New Construction: Yes ❑ No Er"'FHA/VA: Yes ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation___________________Material_._--------------------------------------------- El ----._.___---._____ ..___.____--_.❑ No. of compartments----------------- ---Size--------------------------------Liquid depth*------------- - --------Capacity-------------,------ Disposal Field: Distance from nearest well.-,[d_._�--Distance from foundation--/ r-__.-__.Distance to nearest lot line---------------- ❑/ Number of lines------- ------------ --------- -Length of each line--.-.V.Sr-----------------Width of trench_--- -------------------- Type of filter material�'M pth of filter material______________________Total length_____________ .'------------------- f Seepage Pit: Distance to nearest well __...___Distance fr mfoundation____ __ _________Distance to nearest lot line--.-,�F-------- J Number of pits------%_ _ ___.._.----Lining material_ _Size: Diamete u«` -.Depth____ _ --------------- s} I„ Cesspool: Distance from nearest well-----------------Distance from foundation---_-------- -----Lining material---.---------------------------------- 5¢e:.Diameter------- �--- D.e.pth__-----=_ _.-- --------1--.-----.: _._Liquid Capacity Privy: Distance from nearest well----___------------------------------------_____Distance from nearest building..--------------------------------------- I ❑ Distance to nearest lot line------ ------------------ - -- ----------------------------------------------------------------------------------------------- ----------- - - Remodeling and/or e firing (describe):----------T_1- `s�� -------P-11-97-------------------- _ .fir ----- -----�.��----------• ------------- -----. - - ----------------------------------------- --------------- ---------------------------- -------- ---- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County C7 ordinances, State laws, and les and regulations of the San Joaquin Local Health District. /r • /_ ._ ner d/or Contractor) I (Signed) =- ------------ �'------------- --------------- (Title) -- -- ------------------ ii (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY } APPLICATION ACCEPTED BY____ DATE_ Z 1 REVIEWED BY----------------------------------- ------------ ------------------------------------ ------------------------------ DATE------------- ------------- --------------------------- ' BUILDING PERMIT ISSUED--------------- --------------------- - ------------ DA•TE_---------------------------------------------------------- --•-- - - - --------------------- -- --- -------------- - Alterations and/or recommendations:----- " _ � -- ------ -- f'" ------------------ -----;--- _ -#- ---- ------------- - �— 4 -- ------------------------- - ----- _. ' '��': --=-- --- ---- -------- ---------------------------------- FINAL INSPECTION BY: _Z6 ----- Date.-. S - - -------- C /5 --- - ------------- SAN JOAQUIN LOCAL HEALTH.DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9Th Street r tbOt E.Na:elton Ave. Stockton,California Lodi,California Manteca,California Tracy,California I F.P.0 O.