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FOR OFFICE USE: P, Shs .i ___________________________________---.-.--.----.---._-.. --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ./.. _ 6 . ---------------------------------- --------------------- (Complete in Duplicate) i _----------------- ---- This Permit Expires 1 Year From Date Issued Date Issued /_ .-/'6v` 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 ��---------I/Ili------L'r:. s0IV-----------Z' N�� '�--------- - Owner's Name______________ _ � L � `� �� Z_•---- •- / � Phone Address---------------------- - � .s•...... --------------------------------------------------------- Contractor's Name --------------------------------------------- -Zel- -------7A-<--.-----------_ Phone_ - r Installation will serve: Residence D�Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---f--- Number of bedrooms _"--Number of baths __f--- Lot size ------ ------------------------- Water Supply: Public system ❑ Community system ❑ Private [E-"epfh to Water Table ------_ 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--------------------) No U]-"New Construction: Yes ❑ No ❑f FHA/VA: Yes ❑ No ❑-" TYPE OF INSTALLATION AND SPECIFICATIONS: . __-. �_ _�- - _ _�...� J (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--------------------------------Liquid depth---------- ------ --------Capacity---------------- ------ \ . Disposal Field: Distance from nearest Distance from founclation___ Z?_------.Distance to nearest lot line_��___1_1___ ❑✓ Number of lines_________.__�_V --------------Length of each line___1V---_--------------Width of trench._�_.�`� 0 f Type of filter material____ t'tt! Depth of filter material _ __--------- otal length_-_._�Q--------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation------_l___------- Distance to nearest lot line-.--------------- ❑ Number of pits---------------_--.-Lining material------_. Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--- ----------------Lining material __.-__------------------------------- El -.--_ __--__.-_--_-.__-._._--.❑ 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):__._______ C _ _ ----------------------- ------------- ---------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- ------------- 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 rules and reguf ions of the San Joaquin ocal Health District. C_ � / ,j r (Signed)-------------------_-----c-l`/ /�': �`�zs�l-- -------�/SlS----,�"�- Owner ^nd or Contractor OY�----------------------- (Plot __ - r`--------- ----y---------------==--=----__:_------ (Title}=- __ _ - ..--------_---- Plot Ian, showing of lot, location grs stem in relation to wells, buildings, etc., can be placed on reverse side ( P 9 f Y 9 � P, P )• FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--_'�77___i- .o---------------------------- -- ---------------------------------------- DATE-----, ----------------- -- REVIEWEDBY------------------------------------------ -- ------------------------------------------------------f-- --------------------- DATE-----------------------•--------------------- -------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-----------------------------:---------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------•---- ------------------•-------- ---------- ---------------------------------------------------------- ----------------------------------------------•------------ ----------------•---------------------------------- FINAL iNSPEC - ----------------------- � '� Date. -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haalton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street � t z Stockton,California Lodi,California Manteca,California Tracy,California � s I