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FOR 0FF4CE USE: ------------------ ---------------- -- --------- APPLICATION FOR SANITATION PERMIT Permit No. ................... (Complete in Duplicate) _ 1 �j� Date Issued ---9--_7 ..�.- - ----------------------_------_-- ..___.__--..___,._._ �' This Permit Ex ires' Year From Date issued" Application is hereby made to the;fSan 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 = e. jSSO - Coc c.rFG-@1� w e ?4 4�_,IX------------ ° ... 1.de _ . -.�. JOB ADDRESS AN LOCATION" ----------' OwnersName__.._ ------------ Phone------------------------------------ Address-----.--IV ex--------- 11-.I_y161-1'-------- ---:--------------------------------------------------------------------------•-----------------•----------------•- Contractor s Name_-/ ___ . ----------- Phone.---••----------------------•------ i Installation will serve: Residence V] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' 1 i Number of living units: _--_ Number of bedrooms-_._ Number of baths ---I--- Lot size ------- ------------------------------ Water Supply: Public system ❑ Community system ❑ Private V Depth to Water Table -------- ft. Character of soil to 'a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam f] Clay [] Adobe ❑ Hardpan_[ Previous Application Made: (If ye . pp s,date........... ........) No F1New Construction:;Yes ElNo ❑ FHA/VA: Yes [INo [I TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspoo17permitted if public sewer is available within 200 feet.) i Septic Tank: Distance froml'nearest well-----------------Distance from foundation-------------------Material______..______-____..._.__----_---_..____..____- Dis osal Field: Notance f partments-------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- ❑ compartments i P ihnearest well_-�?!--.--.Distance from foundation_`A_�.__.._Distance to nearest lot lline_ ______________ ' Number of links--- --------------=--------------Length of each line----74--------------------Width of trench._��--------------- I Type of filter i�ateria ., r 1��-_��---------- ---Depth of filter material--�?-�--_-----------Total lengfih__-��----_--_-__------_------------- i i Seepage Pit: Distance to neiarest welle_ ___-_Distance�from//foundation__ _/D. istance to nearest lot line_1-_ __.--.__ ] Number of pits-/------------------Lining material-/--------.-.Size- Diameter._.._____._..._-------Deptn__ __.__.-'� i33 Cesspool. Distance from) nearest well-----------------Distance from foundation: -- -------------Lining material-_-__________________________________ N ElSize: Diameter------- --------------------- - Depth--------------------------------1AA-----------Liquid Capacity----------------------------gals, it * Privy: Distance Illine _ ncFrom nearest building------------------------------------------ e Distance to 'a est lot I nll ]! e--------------- ------- y-------- --------------------------------------------------------------------------- Remodelingand/or repairing (del`cribe)-------------------------------------- ---------------------------------- "-----------------------------------'-•---------------- ------------- r ---il I ------------------•-- .!AR4 j_j----------------- I II I hereby certify that I have prepared this application and that the work will$C- done in-accordance-with San Joaquin County ordinances, State laws, and r s and re ations f f Joaquin Local Health District. (Signed)---- --- - ----------- -- ------- ------ ----------------------- ---------------------- (Ow and/or Contractor) _ (Owner By:----------------------_---- - - ••------------------------- ---------------------------------------------------------77 (...i 1 -- ------------------------------------- -- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 64 placed on reverse side). il. FOR DEPARTMENT USE'ONLY F APPLICATION ACCEPTED BY i �d -- --- ------, DATE--- REVIEWEDBY--------------------------- I` ---------------------------- DATE------------------------------------------------------------ BUILDING ------------- ------------- - --------- - ------------ - ------------------ BUILDINGPERMIT ISSUED---------- ------------------------------------------------------------------------------------------- DATE----- ------------------------------------------------------ Alterationsand/or recommendations:--------------------------------- --------- -----------••-----------------------------•----------'- •------------------------------------------------------- ------------------------- --------------•----- ------------ ------ -----------------------------------------------------------------------------•--------------------------------------------------------------- -------------------'------------•------------------------ ------------ --------- ----------- -------------•----------- -- ------------------------•-------------------------------------------_1--------------------- -----•------------------------------ -------------------- --- ---------- - -- ------ ----------------------------------- •---------------------------------------------------------------------------------------------------- IM if FINAL INSPECTION BY:_:'A` -" e 110 ?.' 5 '--------- ------------- bate... _ G.'�'?-- - SAN JOAQUIN LOCAL HEALTH DISTRICT I� 1601 E.Hatellon Ave. 300 West Ook Street 124 Sycamore Street 205 West 9th Street Stockton,California i� Lodi,California Manteca,California Tracy,California I I F.P.0 0..l