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FOR OFFICE USE .._ - -- ------------ - APPLICATION FOR SANITATION PERMIT Permit No. -- ......... ...... -f'=--------S-_} � -- /f /� (Complete in Duplicate) +-r - j ..., .E. Date Issued - --- --,--�,__:___________________________________ This Permit Expires 1 Year From 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. i JOB ADDRESS AND LOCATION-----------��_��__��.---_��__- -----------------------------••--------•--•--------------------------------------- _ Owner's Name. -„ntt-, Address_... �-- - ------------------------------------------------ ---------------------------------- Contractor's Name--__--_-_--0,__X--_----_' .r. _ i t Installation will serve: Residence ErApartment House El Commercial ❑ Trailer Court El Motel ElOther [INumber of living units: ___�__ Number of bedrooms _____f'-Number of baths ---__f .. __- Lot size ------ d� __ __. _ p _____________________.._ Water SuJIy: Public system Community system ❑ Private ❑ Depth to Water Table .------- ft. .. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E Clay ❑ Adobe❑ Hardpan ❑ I Previous Application Made: (If yes,date....................) No D"'New Construction: Yes ❑ No 3-- FHA/\/'A: Yes ❑ No 0-� TYPE OF INSTALLATION AND SPECIFICATIONS: .- (No eptic tank or cesspool permitted if public sewer is a4liable,within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation__ --------------Material------------------------- ----------------------- 4 ❑ No. of compartments--------------------------Size----- ;= = .= -----Liquid depth------------- ----- Capacity----------------------- Disposal Field: Distance from nearest well-----------F•:f.Distance from foundation_.______-___.Distance to nearest lot line----------------- ❑ Number of lines-----------------------='--------Length of each line-----------.-----.-.----------Width of trench-!----------------_-------------- ---- 'De th.of filter material-----------------------Total length--------I--------------------------------- 0 Type of filter material_______�_________ p j.3�' % '. Seepage Pit: Distance to nearest well__-.............--_--Distance fro foundation----.---------------Distance to nearest lot line___-_..__..__... f _ Number of pits___________ ____ Lining material_.��104/��ize: Diameter___3 _`�__..___Depth--.'. ---_____--__-_.-. . � i Cesspool; Distance from nearest well____________-_Distance from foundation._._______..______.Lining material------------------------------------- 61 s ---------1i Liquid Ca pacify-1gals. 1 ❑ Size: Diameter----------------- --� -- Depth---------------------- ------------------ q �� ------------------------- Privy: Distance from nearest we1P__,------_-----------------------_-------------Distance from nearest building_________,___-----______-_____--_.____..._. ❑ Distance to nearest lot line______ a.-- -- # j Remodeling. and/or repairing (describes:------- + f--�'----- 709 --- �%�..�. -- LI>e13�1,1111-. I r j t a 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,_ nd rules and regulations of,te Sa ohquin Local Health District. (Signed) f (Owner nd/ar Contractor) Y ---------- ---- r �c�rt �.-� l -. --(Title)-- ""` r ' (Plot plan, showing size of lot, loca ion of 7 _m in relation to lells, buildings*etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ��y� I --- ° --- ----------._ DATE--------Z �'------ - BUILDING PERMIT ISSUED----- ------------ ----'------------------------------------ w-------------I... -- -------------------- DATE -I- --- ------REVIEWED BY------------------- - ------ ---------------------------- ------ -- Alterations andyor recornmendatiPns: . ! 2 ------=`�------------- � ' -�" = "' --------------------------a ---------------------------- -------- ------------------------ ................... ....... ----------------- --------------------"-----------------------------------------•----------------•---.................. FINAL INSPECTION BY:.-------- ---- - ------ Date--- - -------------------------------------------------- SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California I F.P.C C.