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FOR OFFICE USE: D APPLICATION FOR SANITATION PERMIT Permit No. lks�----------------------------------------- 7 _ ----------:--------------- -- ---- --------- (Complete in Duplicate) 3 . --------------------------------------------------.__. This Permit Expires 1 Year From Date Issued Date Issued _---r. ____ ____ 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 LOC ION----------- 9- `" _ Gzs_�-- T-----------g-------�-:-v----------------------------------- -0 7/1 Owner's Name--------------------------------------- -------__ � . ._. Phone ------� Address `•3p 3 a2 ----_----- -••-•---- --------------------------6------------------------------------------•----------...------------------------------------------------------------------ - Contractor's Name__-_________.______ e $ - �� -i �f y' ------------- - Phone Installation will serve: Residence [g"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r g Number of living units: --/-- Number of bedrooms _r;__ Number of baths __/_ Lot size -__ ___l ___ _1Q ---------------------- Water Supply: Publicsystem pp y: [Community system ❑ Private ❑ Depth to Water Table��-eft. 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 [Y�New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Tank: Distance from nearest well------- ------Distance from foundation____--_____- Material_-__...-_-__-_-_-_._-_______--_.._____.-----.--_. No. of compartments..,,_ -------------t---Size----------•-----------------=---Liquid depth--------------------------Capacity------ ---------------- i Disposal Field: Distance from nearest welL�_Distance from foundation.-,R.4-- ,-..--Distance to nearest lot line-.__.�_-__- of i fj Number of lines___.____/ __.____ Length of each line..-_ _______A-__-.__Width of tTench______,;-_�_____---_----_____ I Type of filter material.a`__`_h7i4,____Depth of filter materiaI__.�R__ ......Total length....... ------------------------- � s Seepage Pit: Distance to nearest well--------------------_Distance from foundation-------------.--.-..Distance to nearest lot line--_--_-.-.-_----_ 00 ❑ Number of pits__________ ___________Lining material--------------------- Size: Diameter-----------------------Depth--------------------------------- � Cesspool: Distance from rearest'well-----------------Distance from foundation--------------------Lining material-------------------------------------- —0 Size: Diameter---------- "------------.___Dept h----------------------------------------------_----Liquid Capacity_ gals. Privy: Distance from nearest well__«_ -- -------------------------------------Distance from nearest building--------.-----------------____..--.._. m ❑ Distance to nearest lot line.... -------------------_--------------------------------------------- ' Remodeling and/or repairing (describe)=---------------------------------- --------------------------------------------------------------•---------------------------------------------------------' --------------------------- ------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- --------------------------------------------------- Vy I hereby certify that I have prepared this application and that the work will be done'in accordance with San Joaquin County ordinances, S fe laws, and/ruls and regulations of the S n Joaquin Local Health District.(Signed)-- --- - ------------ _---- ---(Owner and/or Contractor) BY: - {Title} ---------------- ------------------ 1 (Plot plan, showing size of lot, location of system in relation to Is, buildings, etc., can be placed o reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. �`I - ---- - ----------------- --------------I------------------------ DATE--- �-' z (°-57-------------------------------- REVIEWEDBY--------------------------------------------- --------------------------------- ------- ----------- -------------------------• DATE------------- ------•- •------------------------------------ BUILDING PERMIT ISSUED----------------- ----------------------------------------------------------F--------- -------------- DATE--------- - -`----- Alterations and/or recommendations:_- ____#___.:--------- - --- -------------------------- ------------ ------------------------------------------------------------ -------------------------------------------------------- -------- --------------------------------------•-------------- -------------------------------------------------------------------------k--------------------.---------------------------------------------------------------------------------------------.-----------------------_--------- ------------------------------------------ ---------------------------- -.-.._.------------------------_._--..._.-_-.--_...-.._--------------------_--- ---------------------------------'------------------------•--------------------------------------------------------.-----------.----------------- ------------------------------------------. I' {_ _.-_._--__-..--_-_.-.-_______--._.3-__-.__._____.b� ..______._._-__.__-.._--..---_-._---_._. Z-._ •FINAL INSPECTION BY:--- -- Date.----- I SAN JOAQUIN LOCAL HEALTH DISTRICT l 1601 E.Hazelton Ave. 1, . a� -300 West Oak Street, 124 Sycamore Street 205 West 911%street Stockton,California Lodi,California Manteca,California 4 Tracy,California F.P.CO. I