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FOR OFFICE USE: -------------------=------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .......................... .--------_---------- .__ '"This Permit Expires 1 Year From Date Issued ^}: 2-q?_e??,eo_0S Application is hereby made to the San Joaquin Local Health District for a permit to constru i all the work herein des ribed. This application is made in compliance with County Ordinance No. 549, C� -- I itSq-b 9._V > C.o-0-740 JOB ADDRESS LOC T N_.__:_ r -- � - ' sem. h �-0 �_ Q Owner's Name___ _ : Address------- ---- q f -------- - - ----- --- % R OLL Contractor's Name- ' ----------------- Phone_ �i. ---", Installation -- will serve: Residence ( partme t House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � ! s' �C Number of living units: ___l___ Number of bedroom_._ Number of baths _______ Lot size _Yft. __________________�_�1______ I � �. Water Supply: Publics stem ❑ Community system ❑ Private i Depth to Water Table Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loam OV Clay Loam ❑ Clay ❑ Adobe❑ Hardpan C-.,p, Previous Application Made: [If yes date____...___,_.._-.._} NaLo ew Construction: YesEr o ❑ FHA/VA: Yes Fr--No --TYPE--OF INSTAL-L-ATION-AN D-SPECIFICATIONS: = - - _: - (No septic tank or cesspool permitted if pc se is available within-200 feet.) p -�- Se tic Tank: Distance from nearest well_ istan frogs fo ndaLon__. ___ r _. fr f Mat ial_5...-1t�Z- -- ------------------------------- No. of compartments.. .-._.____._..__Size g_ .-.__Liquid depth_. _ ___-_--_Capacityl,.,- Dispo al Field: Distance from nearest well��__Distance from foundation--- Distance to nearest lot-1 �,T----------- __ Number of lines_______ ___ ______ _ Length of each I ne_ _Q___ _©_-. Gz�IV idth of trench.�,�___0--------------- Type of filter mater _ - Depth of filter maferial__j.Cj_pl----------Total length_.___--s--~0------------------__ { Seepage Pit: Distance to nearest well_._._---__._ __--.____Distance from foundation___________________.Distance to nearest lot line_____-..___.__-__ ii ❑ Number of pits----------------------Lining material--------------------_.Size: Diameter—--------------------Depth-------------------------- Cesspool: Distance from nearest wefi-----------------Distance from foundation--------------------Lining--material--_ ----------..-_-.-___._______ Size: Diameter--------------------------------------De th__--=-------- ---- ------Liquid Capacity ----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_..._____.._______.___-_-_-------.-.___ ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):------°-- ---- - -- --- ------- ------------------------------------------------------- ---------------------------------------------------------- .: I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta and rules and regulations of the San Joaquin Lo all Health Dist t. &JA(Signed)--.- 1�� i-- ---- ------( Contractor) BY:---------------------------------- -- ---------- --- ---- - ---- ----- -(Title)---------------------- -------------- -- (Plot plan, showing size of lot, location of system in ation to wells, buildings tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --- .----- ----- DATE---------1 `_Z - rCt ----------- REVIEWEDBY---_-------------------- ------------------- ------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------- ------------------- DATE--------------------------------•-----------•-------------- Alterations and/or recommendations------------------ ---- ------- ------ - ------------------------------------------------------•--------------------------•------------------ -------------- ------------------------------- ----- - ----------------------- ---------------------------------- ------------------------------------------------------------------------ I ------------------------------------------------------- ------------------------------ ------ --• -------- ------- ------- ------ -------------- --------------------------------------------------------------------------------------- -- ------------ ---------------------------------------- ------f. . ------------ . .----- -- ------------ ---------------------- - ----------------------------_--------------------------------- zS_i7 FINAL INSPECTION BY:_ =--- -- - --------- Date---------- ---------- ---------------------- ---------- 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-P.c o.