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FOR OFFICE USE: 4 APPLICATION FOR SANITATION PERMIT Permit No. .0 -ol_.. ------- ------------------------ ------------------------ _ ----------------------------- -- ------------------------ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ___ --- ---- -------------------- - _ h _ 020 Application is hereby made to the San Joaquin yLo E �He`alfh_D�strict for a permit to construct and install the war Herein described. This application is made in compliance with County Orginance No. 549. I"TC- . ADDRESS AND ttLOCATION ---- ----- ------------- JOB Owner's Name-----aC a-•---= ----,-=------ ---------•--------------------- - - -- ------ ---------- _... - - ------.--- Phone--YzJ-�-----`Y---Y-7-7 Address_ 2 .. .--- �,... FZ0---- ..-... ... .---•---•----•-------•-----------•---- r Contractor's Name-------- - ---------------------------------------- -------------------------------•------------ Phone....._-------------------_-----•- Installation will serve: Residence [t']'' Apartment House ❑ Commercial ❑ Trailer ,Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _-J... Number of baths _ ___ Lot size -------- ___________________ i Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. I 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 a' New Construction: Yes ❑ No [�J-- FHA/VA: Yes ❑ No Ej— TYPE OF INSTALLATION AND SPECIFICATIONS: =(No-septic-tank or cesspool-permittedrif-public sewzs-available-within,200 feet.) W -- SP k f eptic T k: No} of compartmentst well-elm":_____Distance from foundation__ _'____-.Material_______________________...________..._____.-... Ze Liquid3deth---- ---------------------Capacity----------------------- � � Disposal Field: Distance from nearest well__5_0--------Distance from foundation____ 1 /; _ �Z ?____ --__.Distance to nearest lot line__ __---_---- C� �- Number of lines-----------f------- -- ---------Length of each line-------lee--------------Width of trench...f_e----------------------•-- Type of filter material___.?Yc_ DeVh of filter material______ Total length------ __'_________________________ Seepage Pit: Distance to nearest well-----_---__----------_Distance from foundation-------- ---------- Distance to nearest lot line----------------- Number of pits----------------------Lining material----------.------------size: Diameter--------:--------------Depth--------------------_------------ r Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material.........._._.._________--_-_--_-_ -_ Y ❑ Size: er-- gals. --------Dept --------------- Li uid Ca acit Privy: „ I Distance from neares ------------------------_____________________Distance from nearest building--- -----------------------•------------- b ❑ Distance to nearest lot line--------- ---- ----------------------------------------------------- ------------------------------------------------- -------- Remodeling ----Remodeling and/or repairing (describe)=-------- - -------1--;---------------- -------------- ------------------_--------- ---------•-----------------------•------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- -- -----------------------------------------------------------------------------------------------------------------;---- ---------------------------------------------------- --------- 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) `-.'--� ----------------------- -------------------------------(Owner and/or Contractor) By:--------------- P- 4 --_��;_-�� : w __ ------_--------:--(Title)---- --- ------------------- ------ ----=w----�-(Prot plan, showing sizlot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY pp / APPLICATION ACCEPTED BY------ r te ........------------------- ----------------•----------------------- DATE------- ---- -----'-- ---- REVIEWED BY------------------------------------------ ---------- DATE------------•-------•-- ---------------------------------- BUILDINGPERMIT ISSUED-------------------=--------------------- ---------------------------------------- ------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------- - --------------------------------- ---------------------------------------------------------------------------------------------•--------------- ------------------------------------- . ..... ate-------- ---------- rrte�}} `Q ......-------- --------- FINAL INSP D - - - ---- --- ,�+c--- ---1---� -- SAN 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 F.P.CC.