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FOR OFFICE USE: �1 3 ------------------ ----- --------- ------------ Permit No. .-�ff_�i�--- ___- _ APPLICATION FOR SANITATION PERMIT ---------------- ----- - 7 / (Complete in Duplicate) Date Issued ----- --------- -------- ------- ----- _----.--- This Permit Ex fres 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 describe . This application is made in compliance with County Ordinance No. 549. "/J-, 007 pS 01 JOB ADDRESS AND LOCATION_. !4"-----f----------- Owner's Name------ A�•a''° �t`— ---- -------- Phone- Address---------------��'----•`�-------�- --''- ----:�=- �--�------------------ -------��°-------------------- - Phone------------------- •---------- - -------------------------------- --------- Contractor's Name--f-- - j—_—Z------------------- -------------•--------- Installation will serve- Residence p Apartment House [I Co ❑ Trailer Court E] Motel ❑ Other [3Number of living units: _I------Number of bedrooms -------- Number of baths -------- Lot size Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table Clay Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Cla Adobe ❑ Previous Application Made: {If yes date....................) No F-] New Construction: Yes El No ❑ FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: _(No septic tank,or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well----__._-----._Distance from foundation----------------- 5iLi uid de th---------------Mateial-_-.-_-_.-.----_._C._a..._aci.t-Y - ..._..._--__. ❑ No. of compartments-- ------- -- - ---------- line... Distance from foundation----!7-..-.--.Distance to nearest lot .___...____.. Disposal Field: Distance from nearest wellV s _. /',/l.�'} Width of trench.1---til--------------------- Number of lines------ --------------- Length of each line_- -,_-= re Total length---.-/-_-- f --------- --------- Type of filter materiah��_�_--.-- .._Depth of filter material.._ . ...__- -. g .1 Seepage Pit: Distance to nearest well _...__...Distance from foundation_--_��--___.....Distance to nearest lot line.._____--.- Number of pits--- ----------------Lining material_ '? !~' -----Size: Diameter.__ 3 ._------Depth_- _—: Cesspool- Distance from nearest well-.------___----Distance from foundation_..................Lining material_..---_....-_---------- -- gals. F] Size: Diameter-------- ----------------------------Death----------------- -- - - - ------------------------ Liquid Capacity Privy: Distance from nearest well------------------------------------------- _ Distance from nearest building------------------------------_-----..._. ❑ Distance to nearest lot Ione............. __- --------------------- - --- ----------------------------------------------------------------------- ---------------- --------------------------------------- Remodeling and/or repairing (describe):-- ------------------------ ---------`------------------......-- _--.-.-_. ----------------' _ _ _ ______________________________________________________________________________________________________ _______ ______ I hereby certify that____ __ I have prepare_ _ _ __ d thi_ s applicati____ _ __ _ on and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules nd regulations of the San Joaquin Local Health District. . e ( ra n /c _r Contract ) � By:----------------'------------------------------ -------r- _ ---- ---------- ------------------- ----------------------- rtl —(Plot plan, showing size of lot,-Toa on f system letio'rt to wells;buildings, a#c., can 6e placed on reverse sid-e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y .-f� �'�'��""`' ' " �-- ------------------------- I -------- DATE....: --�"�-------- ---- - ------------ ---------- __ � REVIEWED BY-------- -------- ------------ ----------------------- ---- ----- -------- ----------------------------------------------- DATE----------------------------- -------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.____, Alterations ATE-- - Aiterations and/or recommendations:--------------------------------------------------- -------------------'---------' ------------------------------I--.--.--.--.--.--_---------------_----_----------------------------I------------------------------------------------------4--------I---2------------------------_--------_--_----I---------------------------------------------------------------------------------------------------- ---------------•------------------•-----------------------------------------------------------------------------------------------------------------•----•-------•----------- --------------------------- ----•------••-------•--------------- - 1 ' Date-- .! -- - --------------- -------------- FINAL INSPECTION B/ -r ------ --------- ------- k14 SAN JOAQUIN LOCAL HEALTH DISTRICT r 1 * 124 Sycamore Street 205 West 9th Street 301 E.Hazelton Ave. 300 West Oak Street Manteca,California Tracy,California Stockton,California Lodi,California