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FOR OFFICE USE: — -; -----------I--------------------------------------- ---------- ------ -------- --------------- ------------ ------------------------------------------------------------____.:_.__--_-___--_-.---_______ APPLICATION FOR SANITATION PERMIT Permit No. fi1 ,�� =------------ -------------------------- - ----- (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 compliancewith County Ordinance No. 549. JOB ADDRESS AND LOCATION___._1 •�� L - c��- ,. _ /lot' Owner's Name �` 1 ---------- t----------------------------- ----------- Phone - ------------- IAddress------------------ - Alp, 4Z__ �--'--•-----_-------- ---------------•------ y . ------------••-- IContractor's Name-- ------ l .. --- - -- -------------'-----------------------------------I-----------------I Phone----------------------------------- 'I Installation will serve: Residence E] C-] E]Apartment House Commercial Trailer Court Motel Ll Other Number of Living units: __�____ Number of bedrooms .3___ Number of baths Y Lot size ____-„��~�'!+•!l� y. -- --------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ , Adobe ❑ Hardpan Previous Applicati n Made: (If yes,date___________ --------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ N r tOr STYPE„OF INSTALLATIQN ANDYSPRQF1_CATIONS: - _ _. .� ,d �T _ !F,� i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V Septic/Tank: Distance from nearest ---Distance Distance from foundation'_ .......Material___.- �-�t,� ----------------- Disposal field: Distance from nearest well----- �._Distance`f om foundation uidedQ th-.Distancel Capacity_,1 y, No. of compartments______ __________Size_: q p __ i"to nearest lot line.S'r . Number of lines_________ G Length of each line ` Width of trench Z. -------- Type of filter material-------- c _'___--Depth of filter material------l�-_`_'-------Total len'gthG ------___ .-------_ Seepagk-Pit: Distance to nearest well------f 1?C9"_-Distance from foundation____( _.`. .._ Distancalto nearest lot line- "Z ine_ Number of pits- - Lining material-------s5,; �__...Size: Diameter_ _ --__________-------- Cesspool: Distance from nearest well----_---------___Distance from foundation-----,--------------Lining material__-_--_-._..__--________-- - ❑ Size: Diameter--------- - ----- --------------------Depth---------------------------------------------- -Liquid dapacitY= gals. I Privy: Distance from nearest well_________________ Distance from nearest building' _-._______-_____.-_____ Distance to nearest lot line--------- ------------------------- ----------------------------------------------- I ------------------------------ t Remodeling and/or repairing (describe)----------------------------_,------------------------------------------------------- -•------------------------------------------------------------------------------------------------------------------------------------------------- I --------------------------------------------------------------------•--------------•---------------------------------------------- ------------ ---------------------------------- k I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. (Signed)- ------- --- -- -- - ------ vwu By - --- -- -- ------- -------- t --(Title) -_ �_- - -- - --- - 'an or Contractor) -------- - ------------ ----------- - ----- - - ----------------------- (Plot --- - Ir plan, showing size of lot, location of sys m'`in relation to wells,-building s.Netc., can be placedon reverse side). FOR'DEPARTMENT USE ONLY` APPLICATION ACCEPTED BY \--------- DATE--y� �l ---- REVIEWED BY ------- ------------------- ----------------------------- ------- DATE----- ------------------------- --------------- UILDING PERMIT ISSUED ------------------------------------------------------------\:-- DATE----- ------------------------------------------------------ Alterations and/or recommendations:_. ------------------------------------------------- M .- V-1 --------------------------------------- ---------- --------------- --------------------------- ' -- -------------------- - ------------------------------ ------------------ ------------- ----------_-----------•------- ----- I ----------------------------------- FINAL INSPECTION BY:.�.-__-.. Date_�_s�”- �`� �O ------------- ,r. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street } 124 Sycamare'Street'-"40 205 West 9th Street '+ Stockton,California Lodi,California Manteca,California Tracy,California