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FOR OFFICE USE: ` --------------- - ------------------ --------------- APPLICATION FOR SANITATION PERMIT Permit No. 1f"?_ ----------- -------------------------------------------- ___.__`r_Z.. --------------------------------------- ------- -------- (Complete in Duplicate) ------------------------------------------- ______________ This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and i tall the work herein described. This application mad7_2e..in compliance with County Ordinance No. 549. ",c) s ppm r0�47 40 its JOB ADDRESS AND LOCATION--,,&,, .,,_ ✓- J ' ----------------------------------------------------------- Owner's Name-----------go ------ - ---- ------ ---------- ------------ -------------- Phone Address-------------------- A-l--f---- -•----- --- ---------------- ------•------------- ----- Contractor's Name------ r!!9'?.° --------•---•-- ---._. Phone----------------------------------- Installation will serve: Residence d+ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I------Number of bedrooms _,2 __ Number of baths --I___- Lot size ____ ------------------------------- Water Supply: Public system ❑ Community system ❑ Private. ) Depth to Water Table L_V_ ft. CZ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay, Adobe ❑ HardpanAV Previous Application Made: (If yes,date-----------_________a No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4 ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from: nearest well________________Distance from foundation-------------------Material_.._____._.___.-----------____________...__-___. q ^, ❑ No. of compartments---- ---- - ------------Size--------------------------------Liquid depth--------------------------Capacity-------------- -------- Disposal -------Dis osal Field: Distance from nearest well- v_._.__Distance from foundation_. __ Distance to nearest I t line__ - --------- r Len �� ------ Number of lines________________ gth of each line______ ------ --- of tren h- -- -___.__________-_.__ Type of filter materi _, .._Depth of filter material___ -------______.Total length_____ ____________________4._______ Seepage Pit: Distance to nearest/Iwe111 -.._.______Distance from oundation f0 ______- Distance to nearest to line__ 2 AA Number of pits.--.-!__-------------Lining material./__-_---Size: Diameter---15 --- - --------Depth_��' -------.--__._____...__ Cesspool: Distance from nearest well--------------___Distance from foundation------------------- Lining material-------------------------..--------__ ❑ Size: Diameter----- ----------- ------------------.Depth------------------------------------- -- ----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well________________`_-______---___.---._________Distance from nearest building.-..---------._______________.____..._. ❑ Distance to nearest lot line- ----- =---------- ------------------------------------------------------------------------------------------------------ Remodelingi,•and /br repairing (describe):----- •--- -------- --- - -'*-'---------------------------------------- ------------------------------------------------ ------------------------------------------------------------------------- ---------------------------------------------------------------------------- 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, and r es and regulations of the San Joaquin Local Health District. - (Signed)--:--- --------------------- - --------------------------------------- ---- --- ---- - --(O _ actor) (Owner and/or on By=--------------------------------------- -------------------------------------------------------------------------------------------(Title)----------- --- ---------_- ---- - ---------- 1 (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_ � J REVIEWEDBY----- -------------------------- ---- ------- -------------------------------------------------------------- ------------------ DATE------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------- ------------------------------------ ---------- DATE------------------------------------- ---------------------- Alterationsand/or recommendations:--------------------- --- ----------------------------•---------------•------------- ---------------------------------------------------------------------- ---------------- ------- ------------------- --- -- -------- -------------------------------------------------------------------------------------------•----------------------------------------------------------- -•------ -----•-------------------------------- ------------------------------ ---- ----------------------------------------------------------------------- ---------------------------------- ----------------------------------- FINAL INSPECTION BY:. /_/,_ . .� ct. - Date_ _-� -�° .__.._.__. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California' " Manteca,California Tracy,California F.P.CO.