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r .*FOR OFFI-Gla USE: ------------------------------------ = :_ry_ ��_ ��2 ._.._,.____________________.._..__..___..____.__-__._ _ . _ APPLICATION FOR SANITATION PERMIT Permit No. ___ _____...........__ ------ ----- (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 i compl' n W* C Ordinance No. 549.AV.116101 JOB ADDRESS AND LOCATION---_------- _ ---------- Owner's ______Owner's Name no T Address ....r✓ - ...... - } --- --�--- -}-- �``---- ........................ [% Contractor's Name--- A------•---- -CN----------------------- Installation ----------••------Installation will serve: Residence Apartment House Commercial ❑ p ❑ ❑ Trailer Court ❑ Mot Other ❑ Number of living unitsNumber of bedrooms > Number of baths -- _-- Lot size ___-- -- -- - -------------------------------- Water Supply: Public system ❑ Community system [] PrivateDepth to Water Table ---- - ft Character of soil to a depth of 3 feet- Sand E] Gravel ❑ Sandy �Loam ❑ Clay Loam] Clay [] Adobe ❑ Hardpan Previous Application Made: {!f yes,ddte---------------... } NOA New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: k V (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_._-_______._..__ O -----------Liquid depth--------- ------- --- Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation----------------.-..Distance to nearest lot line__..------_...... ❑ Number of lines.----------------------------------Length of each line------------------------------Width of french.---------------•---------------•-. Type of filter material------------------------- of filter material---=------------------- otal length_.--.._.___._________.___.___.__________. Seepage Pit: Distance to nearest well--.--- --------- ----Distance from foundation__________.....__.- Distance fo nearest lot line-_._...__-_-__ ❑ Number of pits--- ----- ----.."._-Lining material--------------------- Size: Diameter-----------------------Depth --------------- - Cesspool: Distance from nearest we}i ________________Distance from foundation----------------- ..Lining material-----------------------------.--.______ ❑ Size: Diameter. Depth----- ------------------------------- - ------------- Liquid Capacity. ........ - -----gals.. Dis#ince from mares well'`....___________ __: ----------------------Distance from nearest building;----------------------------------------- W ❑ Distance to nearest lot line :-...... ..... . ........... 1 --------------------- ✓ e Remodeling and/or repairing (describe):_...__._ _________ _ ____. _�- ---_�� IN �{Y. ( Q -_ ----------- -----t--- - ------------ ----------------------- --------- o :_=_ _ -__-- _____-- --_:_._:: -_ _ _ -------------- ----------------Ihereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, nd les regu ions of the S oaquin LPcHealhh District. (Signed). f - ® w (Owner a d/or Contractor) 1 By: •- -------------------- -•---- ----------------------------- - ------- ---------------------------- (Tills) '' - ---------- s (Plot plan, showing six lot, location of system in relation to wells, buildings, etc., can be placed on vere side). FOR DEPARTMENT USE ONLY ------ ---- 'APPLICATION ACCEPTED DATE REVIEWED -- BY------------------------ ------- _-------------- -------- ------------------------ -------------------- DATE------------- BUILDING PERMIT ISSUED---------- ----------�----- ---------------------:�----- -- -------------------C=' ,DATE � Alterations and/or recommendations:._ 4Ott � -- -- ��t.� - ---- ---------------- --- ----------------- �; -------------- ----- ---------- - ------ ------------------- ---------------------- --------------------------------- -- ---- -- ----------------------------- FINAL INSPECTION B j._ Date. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Ciak'Street R.• 124 Sycamore Street h. 205 West 9th Street Manteca C alifornia , Stockton,California Lodi, California Tracy,California E.H.9 2M 1-67 Vanguard Press + S a.