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FOR OFFICE VSEL - s ---------� 1_y7 �----------------- f -------------- -------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. . . (Complete in Duplicate) --------------- . f I ,. _ I P P ) ` 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 install the work herein described. This application is made in compliance with County Ordinance No.. 5549. � --- JOB ADDRESS AND L ATION__df'X_--- . ' -___._ - Owner's Name.----- /¢.r � .l � ----•---- --- Phone.---- ------------------------------ --------,F_!- / - ------------------------------------------------------------•-----•------------•------- Phone_ Contractor's Name------• _ff m_7---- Instaliation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /___ Number of bedrooms _�Z - Number of baths -f__._ Lot size ----•-------------- Water Supply: Public system ❑ Community system ❑ Private [[Depth to Water Tablek ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [•Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-------------- 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 Tank: Distance from nearest wel{-----------------Distance from foundation--------------------Material----------------------------__.___.._._.___---_. ❑ No. of compartments--------------------------Size---------------•----------------Liquid depth--------- - ---- -------.-Capacity----------------------- Distance --------------- - -- Disposal ield: Distance from nearest well. _�__Distance from foundation_.) ----.......Distance to nearest lot line__] Length of each line_- .,� Width of trench._ �� Number of lines-----------�--=--- -------------- 9 � -- -----ry-------- -�� -•-------------------- T �---------•-- -Type of filter material___s ,40 .-- -Depth of filter material__-------._.___Total length_______---_-- ---.- 10 Seep it: Distance to nearest well__, &4P��Distante fro foundation__ -.---.Distance to nearest lot line-,______________ Number of pits...../_----_-_____Lining material___71,*4e_Size: Diameter.___ F-!/Depth_.��__________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------.--__.Linin/g'material _.____...__-__----.____._______--.._. !► ❑ Size: Diameter------- -------- �-- ------- ----Depth------------------ ------------------------ - ------Liquid Capacity----------------------------gals. Privy: Distance from nearest we --Distance from nearest building ❑ Distance to nearest lot line- -------------------- - ------------------- ----------------------------- - ------------ ------------ --------------... Remodeling and/or repairing (describe):-_..--}�1�--------7*7---------- -1 -- - -- ----------`�- --------------------------------------------------------------------------}---------------------------•------------------------------------------------------------------------------------------------------------- ------------- -------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a and regulations of the San Joaquin Local Health District. St ned --- �/�/S; - ------,. �1'/` - �n4nd/or Contractor) ( �g ) iBy:------ --------------- ---, -----------------------------------------------------(Title)--. ----------- --- ------------------- (Plot plan, showing size o loft, location of'system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- "-- / ` Grti'' ----------------------------------- DATE------ ._ —~-------- REVIEWEDBY----- - ------------------------- ---------------------------- ----------- DATE BUILDINGPERMIT ISSUED----------------- ------------------------------------------------------------------------------------ DATE----- and/or recommendations:..... --- --- ---------------- ------- - ------------- ---------------------------------------------- ----- - j e— lc1. ------------- ------------------ - --------------•---------- - ----------- ------- -- ------------ -------------- --------- ------------- -------------------•------------------------- --------------------- I ------- - ------------------------------------------------- --------------------- ----------------- FINAL INSPECTION BY:-----!%�.�--- �-- Date ----- f t ------------------------ S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 est Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California