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rUKUr1--K-t USE: = ---------------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. .czl�.-3_j --------------------------- ------------ ------- ------- (Complete in Duplicate) ------------- - -- ------------ --- --------------------- This Permit Ex fres 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construe and install the work herein described. This a plication is made in.com�lI'ce with County Ordinance No. 549. 0 3 'D d C3 � � � d�j ,I �1 fpp Y JOB ADDRESS AND LOCATION----- '- �7!�Z�! Q.-_4--- ��= Owner's Name - f-Ie - ' ----------------- ------ Phone--- t Address------------------ �� -' Contractor's Name_ f { T 7— ----------------------------------•------•------ •----- Phone -. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court []' Motel ❑ Other [j Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ---- Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table -)-b- ft. Characterof soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam [fl Clay ❑ Adobe ❑ Hardpan J4 Previous Application Made: (If yes,date------ -------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No El 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-Size---------------- ------------Liquid depth--------------- ----------Capacity----------------------- Disposal Field: Distance from nearest well---/&-U`.4Distance from foundation__4-'Q.........Distance to nearest lot ------Length of each line-- Number of lines------ -�---------- � g �--,[--------- -------Width of trench---��------------- ------- ` j Type of filter materiae- ---------Depth of filter material-.-..1-9_y__--_..Total length_---- ,r___:____- f� { ------------------- Seepage Pit: Distance to nearest well__--_______-__-.----Distancrom foundation--_-- ---------.Distance to nearest lot line----------------- j Number of pits--------r------------Lining material_ p -k' Size: Diameter- t� Depth--------------------------------- Cesspool: ___________________________ _Cesspool: Distance from nearest well-----------------Distance from foundation__----------------- Lin ing material-___---------- - ❑ Size: Diameter--------------------- ----------------Depth-------------------------- -- - ---- ------ ------Liquid Capacity------------------- gals. - Privy: Distance from nearest well-----------------------------_-_------------._Distance from nearest building ❑ Distance to nearest lot line - -- ---------------------- ------------------------- Remodeling and/or repairing (describe ------------------_---_ _ - - -------------------- I ,, ---------/------------------- •------------•-------•-------•------------------------------------------------------ ------------------ ----- ------ ---------- ------------------------------------------••-----;i---------•--------------------------------------------------------------------------- --------------- ------------------------------------------------------------------------ - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County �Z ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si �' (Signed)) fr�l ......... �- ------------- -------------------- ---------------------(Owner and/or Contractor By---------------------•-- "" '7` 7 Title (Plot plan, showing six o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -. FOR DEPARTMENT USE ONLY Pp APPLICATION ACCEPTED BY--.- 00 - -.- ------ --------------- - - ------------------ ---------------- DATE-----�-a-�-�-~��--------------------------- REVIEWED BY--------------------------------------------- •-------------------------------- -------------------------------------- . -------- DATE----- �---------------- ------- - - BUILDING PERMIT ISSUED Alterations and/or recommendations--------------------------_ . . -------------------------------------- ---------------------------•------------------------------------------------------------------------------------------- ---------- --------------------------------•----------------- ------------------------------------------ -----------'-------------------------------------- ------------------------------------------- ----------------- z -- ------- -------------------------- a / FINAL INSPECTION BY:- �� .��•-_ ,.. --- Date- SAN JOAQUIN LOCAL HEALTH DISTRICT ?' 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California r Lodi,California Manteca,California Tracy,California F.P.r Cl. - ,n