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FUROFFICE USE: ----------- `--- - _"___________________________ _____ APPLICATION FOR,SANITATION PERMIT Permit No.,Rc-�,V .._. ----------------- - --- - ------------------------------ (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 A/ND ------��----- ��'�---- t-.._ C -.t,�_____________________________________ ----------------- ------------------------------------ � �� Owner s Name Phone , t ------------- Address - // 1 Address-----•---------------- Contractor's Name----=�---m::2----- -----'�"'-.. -------•--------•-------------------------------------------•------------ -•---------------------- Phone----"---•-------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _ _ Number of baths -/-- Lot size -------dj_.—b_ � .........._____________._ Water Supply: Public system '6�Community'system ❑ Private ❑ Depth 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_,.,__...,,.__,------) No1, New Construction: Yes E] No FHA/VA: Yes F] No E-]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------___---------Distance from foundation--------------------Material ._..-____,-" ❑ No. of compartments Size-_------------------------------Liquid depth---------- --- -----------Capacity-••---- ---------- Disposal Field: Distance from nearest well -, Distance from foundation-_/ - -.p istance to nearest lot line-- ----------------- ine [� Number of lines___.__."___ ______________...___Length of each line_____---___- �__`--Width of trench--------- , \ , Type of filter material-_____ ._..._Depth of filter material----.__'/ ___l._Total length---------- Q Seepage Pit: Distance to nearest well----------------------Distance from foundation--------- ----------Distance to nearest lot line_______________ ❑ Number of pits----------------------Lin ing material-----------.-----------Size: Diameter-----------------------Depth-.--------.---------------------- Cesspool: D] stahce from nearest wef€______.____"..._"Distance from foundation-------_------------Lining material------_---------_____________--___-- ❑ Size: Diameter-------------- -----___"De th_..._____""-_"--___------ Liquid Capacity l p ------------------------- q ----------------------------gals. Privy: Distance from nearest wel!_____�------------__________....____...___,_"Distance from nearest building-___"_".__. ---------------------..__._._. t ❑ Distance to nearest lot line-----°------------------------------ ----- Remodeling and/or repairing (describe:--------------Y-V4- y--------j- ___-__._- 4 -_-j.r �-_------ «, / t,p ----- -- -- �--------_-:__----- ----�_ -_:_-- _-----k- ---------------_ - -------------- ____________ __________________ ______________S -- ---- ._____-____-.________________-_-_,______________-________-________.___.__________..____________-_-________________-__________________-_________.___-__________--____.-______.._.-______-___________. I hereby certify that I eve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ws, a� 'r es and e u ations f the S n Joaquin Local Health District. ' i (Signed) ------- ----------------------------------------------------------- ----(Owner and/or Contractor) 7 By:-----------------------------------•---•--- ------------------ --------------- '-----------------------------------------(Title)------------- - �(Plot plan, showing size of lot, location o y tem in relation to wells, buildings, etc., can be placed on reverse side). Oft DEPARTMENT USE ONLY 'APPLICATION ACCEPTED BY-------------r ..... ---..........------------------------------------------------------ DATE------- • �' }��-, ,REVIEWED BY------ -------------- ------------- - - -- ---- - - DATE- •-------------------- BUILDING PERMIT ISSUED --------- ----------- ---—------------------ ------------------• DATE---------------------------------------. Alteratio s and/or recomme ations---------------- ----------- s-------------------------------------- ?!;�s r1 4 ° s a`t r<v.cL `~`-rr �_rg. ------- -- rtt- u ct r - � t r.c � F £ ------ rf fc.N3 t ' FINAL INSPECTION BY----------------- ------ ------------ Date-- -----= l ` f 5 JOA LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lad!,California Manteca,California Tracy, California F.P.Q0. f