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FOR OFFICE USE: a f� 45 - SUS ---- -------- -3a APPLICATION FOR SANITATION PERMIT Permit No. ___�.��.___•__•__._• -------------- -- --------------- 3� (Complete in Duplicate) 9 +'i 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. 549. E ! ; � _�V —1 JOB ADDRESS AND �jLOCATION, _ ,f -:- �,� --Gf�/� --� :00 � f Owner's Name__.._..iXPI ------- �' �� ----------------•-------- -------------------------------- ---- - Phone----•-----------------••------••---- Address------- -------- j ------------------------------------------------------------------------•-------------------.-...----------------•-------------.- Contractor's Name----- '' --v---------------------- ---------------------------------- Phone_.. Installation will serve: . Residence g5,4Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living.units: _-/--- Number of bedrooms _,Z_ Number of baths _F.-__ Lot size __/. Water Supply: Public system El Community system El Private Depth to Water Table satQft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 91--lRardpan ❑ Previous Application Made: (If yes,date_------__--------) No Z�1'New Construction: Yes Z%o ❑ FHA/VA: Yes [ o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: / 1p . ��` Mater':%:L�_ - ---------- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { Septic Tank: Distance from nearest well--j -Distance om foundation / No. of compartments__._.......... ....Sized X_AX ?- --.Liquid depth___ Capacity_ y +o A Disposal Field: Distance from nearest well_ -,-Distance from foundation___` -_- --Distance to nearest loot line # Number of lines-------- ---- ----- ------ ength of each line_j�-_..__________-_-.Width of trench,/-__- -._.._�� 1 �^ Type of filter material. epth of filter material___,, ry--Total length------- ---------------------`--- Dis ice to nearest lot I�ef-.___._ Seepage Pit: Distance to nearest well_. 4 _�Distanc�4ygoe__Size: fou dation_�� Number of pits------/�-----------Lining material_ Diameter-�,, .__.._-_..._Deptho�---------------___.._ Cesspool: Distance from nearest well _.______--------Distance from foundation--------------------Lining material_._.__._..__----____.___._----_.___. ❑ Size: Diameter--------------------------- ^rr:f�Depth-----------------------------------------------------Liquid Capacity----------------------------gals. z Privy: Distance from nearest well-------______---------------------:------------.-Distance from nearest building_.____--__-______.__---_______.________. ❑ Distance to nearest lot line-------- ----------- ---------------------- - ---------- -------------------------------------------------------------- Remodeling and/or repairing [describe]:---- /�lQf/� , ---------------------•-- ----------------------- --------------------------------------------------------------------------:------ --- --------- - re -- I- he-reb-y- - certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulat'ons of the San Joaquin Local Health District. ----------------------------------------- Contractor] (Signed)-•------------ -- - - - --- --- ----�� - ------------ ? (Title)-- -� -------------------- I (Plot plan, showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). i1 ` FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY------------- ------------------------ ------------------------------------- DATE p- �j �S ---------------------------- iREVIEWED BY---------------------------- -------------------------------------------------------- ------------------------------------ --- DATE------------------------ ---------------------------•------ BUILDINGPERMIT ISSUED----------------- ---------------------•----------------------- ------------------- ----------------- DATE--------------------------- -------------------------------- Aiterations and/or recommendations: ----- ------ - -------------•-------------------- --------••---------------------------I-------------------- ---- ------------------- = „c --- - j----` '---------------- ,p - f ------------------------------------- -- -- ---------------------------------- ------------------------------ - -------------------------- ' FINAL INSPECTION BY:.------ ------------------ Date-- ---- = J`--------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street IStockton,California Lodi,California Manteca,California Tracy,California r.P.r n.