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FOR OFFICE USE: --------------------------------------------------------- -- -------------------------- ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) ........ This Permit Expires 1 Year From Date-issued Date issued _- �6 Application is hereby made to the San Joaquin Local Health District for a permit to construct and instail the work herein described. This application is made in compliance with County Ordinance No. 549. '>- ->_.nL_9/ Wee JOB ADDRESS AND LOCATION-_ ----------- ___ .. - ___ �'j'l7 � � -------------•-- ------------ ��qq. �--- Owner's Name------GIl._, 1'�*!--------- -- --- %vim .......... ------- .. Phone--------------------..-------------- Address-------------------!' ....-•-- ------ --------- � �•----------------------------- -------- Contractor's Name----- :_.____.__. �� . � - ------------------------------------------ -------------- . Phone..----••----------•-----•--------- Installation will serve: Residencle [� Apartment House E] Commercial E] Trailer Court El Motel E] Other Other . Number of living units: _1----- Number of bedrooms _�-.- Number of baths----- Lot size _:_- ----------------_________________________ Water Supply: Public system ❑ Community system ❑ Private [N Depth to Water Table LI.'0_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loamr�K Clay Loam ❑' Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-.---_.............) No ❑ New Construction; Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (45septic tan�C of Cesspool permitted-if pukSlic ssew'er is availab7e�wit iin�00 ee ] ~ ' Septic Tank: Distance from nearest well_-'_-----------Distance from foundation-_.--_f__0--------- mm No. of compartments----- -----------------Size---lq- _.1 _,k'_------ .Liquid depth__.-it-------------------Capacity.V�-X57---------- Disposal Field: Distance from nearest ells _g_.......Distance from foundation-__ _o.........Distance to nearest lot line-- /_-----_ h) Number of lines___________ ____ _______-"�_yLength of each line 6'& v Width of trench_.__�.F-.,9-----.__.._--_--.- l Type of filter material-_ .` t- Depth of filter maferial____�y __-_Total length-----ZI_0---------------_--____-- ['1 Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line____..-_------- �! ❑ Number of pits----------------- ---Lining material--.---------- -------Size: Diameter_.........s------------Depth--------------------------------- .W Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material__ -----.___-----------.._.-_____--. {] Size: Diameter------------------ -------------------Depth--------------- ------------------------------------Liquid Capacity----------------------------gals. I Privy: Distance from nearest well__________________________________________ _ __Distance from nearest building_________.._________._.____.____,.___.._. ❑ Distance to nearest lot lire---------------------------- -------------------------------------••------------------------------------ ' ----------------------- ---------•- C Remodeling and/or repairing (describe}-- - ------------------------------ --- ----------------------------------------- ---•--- ---•----------------- ---------------------------•----------------------------------•-------------------------------------------------------------------------------------------------- ------------------------ ------------------ -------------------I-------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancf..s_Sta#e laws, and rules and regulations of the S n Joaquin Local Health District. 1 ------ f --------------------------------- -Owner and/or Contractor) i (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. w w- --- --------- - -- --------------•------------------------- DATE--- ` ------------------=----------------- REVIEWEDBY----------------------------------------- ---------------------'----------------------------------------------------. DATE------------------------- --------------------------------- BUILDING PERMIT ISSUED----------------------------------------- ------— -- ------ - - ( ----� DATE---------- -------------------- - ------------------ y --------------Alterations and/or recommendatio "' - ' ----------------------------- ----------------------------------------------------------- ----------------------------------- ------. = ---- - ----- -------- - - -- -- --- - - ✓er--------------- r-'� �a -A t.6-P---- FINALINSPECTION BY:---- -------------------------------------- ----------------- Date-------------------------- -----•- -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 304 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F-P-C 0.