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FOR OFFICE USE: _-- �---- G_-�_ 5�__.............. Q�. �._. APPLICATION FOR SANITATION PERMIT Permit No. ...... --------------------------------------------------- -- (Complete in 'buplicate) -------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date issued __ �S__. 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 N . 549. JOB ADDRESS AND LOCATION-------------------/ gip f � ?/ --_-_--. ------------- ------------- Owner's ---•-• - -•-Owner's Name--------- ------•--•------------- 15 ---------- ---------- ------ Phone., ------ AddreAddress---------------------------------------------------------- ss------------------------------------------------------------ _! --- ------ - ,- Contractor's Name------------------------------- ---------- -p----- .k -s-- ame1`-----s-- '------ Phone 0 Installation will serve: Residence A Apartment House El Commercial ❑ Trailer Court ❑ ! Mot I ❑ Other E]Number of living units: __(.--- Number of bedrooms _�3-- Number of baths Cot size --- [' '._ .._ --------------------- Water Supply: Public system ❑ Community system ❑ Private-K Depth to Water Table_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ 1 Previous Application Made: (if yes,date-_........ ........) No tM�,, New Construction: Yes ❑ No�' FHANA: Yes ❑ Noj� 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____..-----------------------------.------------- ❑ No. of compartments--------------------------Size---------- ------- ---------._--Liquid depth------------------------------------------Capacity----------------------- 1 Disposal Field: Distance from nearest well-----------------Distance from foundation.-------------------Distance to nearest lot line----------------- CA ❑ Number of lines-----------------------------------Length of each line----------------------------..Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material--------------.--------Total length------------------------------------------ Seepage Pit: Distance to nearest well----/l. l-.._--Distance froA foundation__(________.__ Distance to nearest lot line-------.-__---_._ 1 ; A Number of pits.----------. g Size: Diameter._ �� p r ------_Lining material___ •r:�._.._..-__.Dept Distance from nearest well-----------------Distance from.:foundation-----.--------------Lining material-------------------------------------- Size: Diameter--------------------------------------Dept h.-------- -------------------------------------- Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------_------__________--_-_-. ❑ Distance to nearest lot line - - - -----: -•-y----�------------------------------------------------- --------------------------------------------------------------------- Remodeling and/or repairing (describe)---------- -------- ---------- f --------------------------------- l `----------- - • '` '----------- --- ------------------- -_------..-_----------------------_--._.-.-----------------------------------------_-------------------.--------.-------------------------------------------------------------------------------------------- i ---------------------------------------------------------------------------•_---------------------------------------------------------------------------------------------------------------------------------...------------ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Signed) � l I ' .�Lu �' --_Owner and/or Contractor B ------------------- - . ---- - Title _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---. .---------------- ---------------------------------------------------------- DATE------ 'S .tF ._Sv_sS.----------------------- REVIEWED BY----------------------------------------- - - ------- ------ DATE---------------------------------------------------------- ----------------------------------------- -- _ BUILDING PERMIT ISSUED-------_--------- ---------------------------------------------------------------------------------- DATE---------------------------- - ------------------------------ i Alterations and/om e�ndation ----------------------------------•--------------------------------------• ------------------------------ ----------------------------- --------------------------------------------- ------- - ---------- --------------------------.-- -------------------------- jj I -----------------------•-----------------------------------•----`�------------------------------------------------------- ------ - -- -•--------------------------------------------------------------------------------------- --�++ FINAL INSPECTION BY:............( . ._ Date-.----�---�--__��..� -------------------- ----------------- ------------------ SAN --------------- -SAN JOAQUIN LOCAL HEALTH DISTRICT f 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi, California Manteca,California Tracy,California F.P.Co.