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FOR OFFICE USE: ---.- -_ APPLICATION FOR SANITATION PERMIT Permit No.oZ-----------.•. - ------ ------------- -- ---- (Complete in Duplicate) � ................... This Permit Expires 1 Year From Date Issued Date Issued 6 ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install +he work herein described. This application is made.in compliance with County Ordinance No. 549. / 3 'JOB ADDRESS AND LOCATION___ q ------------ � --------•--•------ --•------------------------ Owner's Name----- s, � _�..�.. --------- ---- Phone---------------- Address-----------_r 0----�----- -"'cam-- Contractor's Name-------- __ ---------------------------------------------- Installation will serve: .Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Numbertof living units: _f---- Number of bedrooms...__ Number of baths _/_._. Lot size _.f�-_- 6____..__- Water Supply: Public system Q—,Community system ❑ Private ❑ Depth to Water Table 70_ ft. Character of sail to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff' Hardpan ❑ Previous Application Made: (If yes,date......... -;--------1 No Rj' New Construction: Yes e— No ❑ FHA/VA: Yes A--INo ❑ r 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---- P.---.------Material... ................ Rl— No. of compartments-_-.--_Z ------- .-._.Size----J-X_..1_�4-r1'......Liquid depth-------- __ ------------Capacity---if A. Disposal Field: Distance from nearest well __0 _...-Distance from foundation.._LP_--_.__.Distance to nearest lot line--A--.�--_-_-. ®� Number of fines-----------I---------------------Length of each line-------`5?----------------Width of trench----4--------.------------------ Type of filter material------4o-'.k._-Depth of filter material-----/�--�........Total length-------9_u__�---------------- Seepage Pit: Distance to nearest well.....---------Distance from fo ndation___.Z.v_.�_--.Distant to nearest lot line__-- �_._._ ul -H__ Number of pits._.__-.__/__-_-__-__Lining material----- Diameter-----3-,3__-.----____Depth---L_S-------------------- - 0 Cesspool:. Distance..from nearest well-----------------Distance from foundation....................Lining material---..-.-____------------..-.--__-----. m ❑ Size: Diameter---------------- --------------Depth-------------- ------------•------ -------- --------Liquid Capacity----------------------------gals. Privy: Distancefromneare _---....__________-----__------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line---------------------- --- ------------- - ---------------------------------------------------------------------------------------------- 1� Remodeling and/or repairing (describe)-- ------------- ------ ------- -------------------••----------------- ----------- _�. 1 --------------------------------------:------------------------------------------------------------------------------- i ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 regulations of the San Joaquin Local Health District. (Signed) t- ` ------------------ --- --- --------------------------------------(Owner and/or Contractor) Sy:------- ------ ------------------------------------------------------------------------------------------(Title)---------- ------- ----------------- (Plot ----(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 APPLICATION ACCEPTED BY-----=------------------------------------------------ -- ------------- DATE------------------- -- ------------------------------ "' �;, REVIEWED BY---------------------------------- ''-:.:... DATE BUILDINGPERMIT ISSUED-------------- -------------------- --------------------------------------------------- ------------- DATE----------------------------------------------------------- Alterations --------- -- - - - Alterations and/or recommendations:- ;C1_ ------- --------�1-=7 1-.------ ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I-----------I----------------- • FINAL INSPECTION BY--------------- f. ---------- - ------------- Date--.------- � -- � -- SAN JOAQUIN LOCAL HEALTH DISTRICT T •: 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street .205 West 9th Street. Stockton,California Lodi,California ManteCar California Tracy,California 4` r.P.Q C3. • J