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FOROFFICE USE; --------------------------------------------------------- ------_-_--------------------------------_-------_--. APPLICATION FOR SANITATION PERMIT Permit No. -------------------------- ---- ---- ---------- ------ (Complete in Duplicate) —�� Date Issued _ This permit Expires 1 Year From Date Issued �f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This 06 plication is made in compliance with County Ordinance No. 549. 025--Coc9 ©b JOB ADDRESS AND LOCATION _ ?u._ Owner's Name -- -•-- 1rx4- - - - ---------- ----------------- ------ Phone----------------------- Address.......... -- 1 4 - ---------------- -- --- --- ----- ----------- Contractor s Name------------- l G. ------ -- ----- --------- --- ------------- -------- ``"��=f'----------.-. Phone-------------------- - -------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other L-i A Number of living units: ___ _. Number of bedrooms _21. . Number of baths __-t___ 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 E] Sandy Loam El Clay Loam ❑ Clay Adobe E] Hardpan ❑ Previous Application Made: (If yes,dote-------- --------1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA; Yes ❑ No ❑ 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 foundation-_._-/�Q_...____.Materia!____--- .--------- . No. of compartments--------y-----------Size-3__A_9Y_S__'__.Liquid depth___-._�---------------Capacify---?9_0 _.___ / j_ Dispos Field: Distance from nearest well...` ______Distance from foundation----fQ______.._.Distance to nearest lot lin ___ -----___ Number of lines_________Y_________________Length of each line-----.-g0--`........._-Width of french_____.�.1----------.--------- Type of filter material--------s_r__rDepth of filter material-------/_lt__.........Total length---/.,Q-!�________________________ ' S Seepage Pit: Distance to nearest well-------------_-------Distance from foundation--------------------Distance to nearest lot line__-______________ �l ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------- --- ---- --Depth-----------------.--------------- 0, Cesspool: Distance f3-om nearest well________________Distance from foundation--------------------Lining material--.________________-_______________ ❑ Size: Diameter- ------- ----------- ----------------Depth------- -----------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest we]---------------------------------- ______________Distance from nearest building.________________.________-.___-_-._-_. ❑ Distance to nearest lot line---------------------------------- --------- ------------------------------------------------------------------------------------------ n Remodeling and/or repairing (describe)---.. ----------------- ---------- -----------------------------------------------------------•--•-------------------------------------------------------- +O -------------•----------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- -------------------------- --------------------------------------------------------------------------------------------------------------------------------- ------------•---------- ----------------------------- --------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- --------- I hereby certify have prepared this a lication and that the work will be done in accordance with San Joaquin County ordinances, State la s, a rules and regul 'ons o the San Joaquin Local Health District. (Signed)... ---•-- ---------------------------------- ---- --------- ------ -- --------- ------------------- -------- -------- J2bp-and/or Contractor) By:---------- t------ --- --- ------- ------------- -------------------------------------(Title)- ----- ------- ------------------ -------------------- - (Plot plan, showing size of lot, location of system in elation to a Is, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------- ---------------------------------------- DATE---- _ - � REVIEWEDBY---------------------------------- --------------------- ----------------------------------------------------------------- DATE------ ------------•----- BUILDING PERMIT ISSUED.------------------------------------------ ---------------------------------------------------------- DATE-------- Alterations and/or recommendations:-------------------------------------- ------- ---------------------------------------- ------•---- -------- ----------------•---•------------- ------ -------------------------------•---------------------------------------------------- ------ ----------------•----------------------------------------------------------------------------------- ----------------- --------- ------------------------- -------------------------------- ----------------------------------- -- ------ ----------------------------------------------------•------------------ ----------------------------------------------------------- ------ --------- ------------------------------------ --------------------- ------------------------------------------------------------ --------------------------------------------------------------- ----------------- _------------- ---------------------------------- ----- --- -------- ------------------------------------•------------------------------------------------------------------- -- -------- --------------------------------------------- FINAL INSPECTION BY:.----. ��'t, `l� ------ --------- - Date.-,�7 y-9-- ----------------------------------------------- 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