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FOR OFFICE USE: _ + = 1 t „ 1 � ' ay --------------------�1..`v� -_. APPLICATION FOR SANITATION PERMIT Permit No. _ _..-_.._ .- ..:._... 4 ---- -- --- -- (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 install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------- S,..�-------------- �� ` , P �-- ------ '--- ---------- ��`- ------------------------------------------------------------------- _L Owner's Name--- ---------------* d ----- N/...------ ---k-7__-------- ------------------------------------- Phone_4�,_.Z_/_?4.3--- Address------- ------------ f ---------- -------46 ---- -----------------------------------------------------------••---------------------------•----------- Contractor's Name-------------•- / ------ -------------------------------------------- Installation ------------------------------------------Installation will serve: Residence []R-`A artment House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.'_; Num er off be rooms . Number of baths __r ^ Lot size ----_1707.X ` _ _________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 40- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date-------------- -----1 No [-New Construction: Yes ❑ No a- FHA/VA: Yes ❑ No [] _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----------------- from foundation___________________ Material------------------------------------------------- F-1 No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity---------- ------------ 1 rr f Disposal field: Distance from nearest well-----------------Distance from foundation_-/ __ ._..Distance to nearest lot line___, ____. l Number:of lines_--.______�______ ______________Length of each line_-----��---_--------'Width of trench---- __ ____.._._______ Type of filter ma- Depth of filter materia!___. a Total length___._ T' Seepage �t: Distance to nearest well_____-----------------Distance��f,roffi� foundation__--�__.Distan`e to nearest lot iine___��__�_`�_-� E_"J' Number of pits- -----------Lining material-��_��Size: Diameter_-_/9-_ __...__.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---------------------- ------------------------------------------------------------------------------------------------------ -------- Remodeling and/or repairing (describe):-----_.- � ��_ [?__.____�_, _/ ,//4�, ..----.� 1 -- -- ------•-•-•------------------------- --- •----------------------•----------------------------------------------------- ------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------- 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 and regulations of the San Joaquin Local Health District. -- �� --• --- ----- By: --- er /or Contractor) 6 -------------------- .� G_C __ _ (Title)----- (Signed) Title (Plot plan, showing size�of ot, location of stem in vela+ion to wells, buildings, a+c., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- ----- - . .-- ------------------------------ DATE------- 1 �� ---------------------------- REVIEWEDBY------------- ----------------------------------------- ---------------------------------------------------------------------- DATE---=----------------------------------------------------- BUILDING PERMIT ISSUED----------------------------•---------------`-------- — - -------------• DATE---------------------------------------- ------------_------ Alterationsand/or recommendations:------- --------- ------ ---------------------------------------------------------------------•-------------••-----•--•-----------•-------------•------------- ---------- --------------------------- - t FINAL INSPECTION BY: ----------------- /!:---- Date---------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT a I 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California _ t