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R OFFICE USE: T --- - ---- ----- ------------------------------------------- APPLICATION�FOR SANITATION PERMIT Permit No. _.�................. ----------------------------------------------------- -- (Complete in Duplicate) f Date Issued 6 K/'/` .._ --- 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. JOB ADDRESS AND LOCATION,.A/�!__ LA---�'�` _' ( �, ----_ ----------------------- Owner's Name-_,/C't.n -•-19 c?n --------- f ------------ Phone---••-------------------•-•-------- Address__1_/: .. ------------------------------------------------------------------------------------ ----------------------------------------------------------------- Contractor's Name -- -•----------r''S. ------ Phone ------- Installation will serve: Residence ®' Apartment House ❑ Commercial ❑ Trailer Court [3 Motel ❑ Other ❑ Number of living units: __j____ Number of bedrooms _.3--- Number of baths Lot size -------------------- Wafer Supply: Public system ❑ Community system ❑ Private [Depth t ater Table P-_r ft. t Character of soil to a depth of 3 feet: Sand E] Gravel E]- Sandy Loam' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,dote--------------------I No New Construction: Yes J�No ❑ FHA/VA: Yes ❑ No ?T_ `. 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_-/0__'____...Material--- ________________________ No. of compartments----- -____-_'`__-_-__Size-_ _A.` _ f?` _Liquid depth. Capacity_Z-Zt!!_a Disposal--Field: Distance from nearest well!_p_-----Distance from founclation__jQ_.`------Distance to nearest lot line-----------57 -` Ems'- Number of lines-------- 7-----------------------Length of each line___.fo4---------------._Width of french----2- --y.__.----------_.- Type of filtermateriah --Depth of filter material-----/X-_---------Total length------ -2` -- __`_ ---------------- Seepage Pit: Distance to nearest well__________ -----------Distance from foundation--------------------Distance to nearest lot line----------------- _ ❑ Number of pits----------------------Lining material---------- ----- - -- Size: Diameter-------------- --- Depth------- ------------------------• .¢ Cesspool: Distance from nearest well_________________Distance from foundation.........-_-_...----Lining material_____-_____-_-__________________._. I E ❑ Sizer Diameter------ ------------------- ----------Depth----------------I-----------------------------------Liquid Capacity--- ----------------------gals. r' Privy: Distance from nearest we]____---------- ------------------ ___---- ___ __Distance from nearest building----._..________.______.________.____..._. ❑ Distance fo nearest lot line-------------------------------- - --- ------------------------------------------------------------•---------------=-------------------- i � Remodeling and/or repairing (describe)-- --------------------------------------------------------------------------------------------- --------------------- -------------•----------------- ---------------------------------- ---------------------•------------------------------------------------------------------------------ ----------------------------------------------------------------------- ---------------------------------------------------- ---------------------------------•-------------------------------------------------------------------------------------------•----------------------------------- 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 anVesan of the San Joaquin Local Health District. (( x 11 (Signed) - ----------------------------------------- (Owner and/or Contractors - By:--------------------------------------------------------------------------------------------------------- -------------------------(Title)---------------------------- ---------------------------------- 's (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY-----/ .t *----------------------------------------------------------- DATE----- UJ--6'_S.. REVIEWED BY------------------------------------- ------------ ------------------------------------ ---------- --------------------------- DATE-------- --------------------- -- -- BUILDING PERMIT ISSUED--------------------------------------------------------------—---------------------------.---------- DATE-------------------------------- Alterationsand/or recommendations----------- ------_-------------- -----------------------------------------------------------------•-------------------------------------------------------- ------- ------------ ---------------------------------------------------------------------------•----------------------------------- --------------------------------------------------------------------------------•--- -------------------------------------------- --------------------------------------- ------------------------------------------------------- ------ ---- --------------------------------------------------------- -------------- --------------------- ------ --------------------------- --- ------------------•------------------------------•-- -.--•--------------. -------------- ------------------------------------------------------- FINAL INSPECTION BY:-.--- e555 - ---rNJOAQUIN �'`� --- Date-.... - -------------------------------------------- LOCAL HEALTH DISTRICT 1601 E.Mazelton Ave. 30Street 124 Sycamore Street 205 West 9Th Street l Stockton,California Lodi,California Manteca,California Tracy,California