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FOR OFFICE USE: /� ,Lm -------------------------- -------------- -- APPLICATION FOR SANITATION PERMIT Permit No. 1.. ............:.. -- -------- -- ---- ---------------------------------= (Complete in Duplicate) Date Issued --_ --_--- i ---.----.---................_.__.._._.___...___:.__._:- This Permit Expires 1 Year From Date Issued /- �S Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thiplication is made in c 'mgance with County Ordinance No. 549. 14� (�7_ Z�,_ocl JOB ADDRESS AND LOCATION /1!?44/-a17-,V Owner's Name------------1-44 'o.-I.- -144, ,R-->-------&.c"I �----------------...--------------- ------- ------ ------- Phone _-- 3-1_7 Address ©�( ^ z _ ? !/.. �'. '"C ---------------------------------------- Contractor's Name------ ry Installation will serve: Residence 0 Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units)' 1r_-_- Number of bedrooms ---P-- Number of baths --/-- Lot size __- r_�.�'�_----��__-.�- __-__.--._ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -I*- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [3--clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes date....................) No 0— New Construction: Yes ❑ No [Y-,.FHA/VA: Yes ❑ No 0' TYPE OF INSTALLATION AND SPECIFICATIONS: p (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--------------------Distance to nearest lot line----------------- ❑ Number of lines-----------------------------------Length of each line Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material -------._.-___-.-----Total length---------------------.------------------- ' i Seepage Pit: Distance to nearest well----- / _.__---------Distance fr m foundation---O-. __..Distance to nearest lot line-�s_ ---- _ � s L� Number df pits------l-.._-_______Lining material-_�A1004,e -Size: Diameter----3-3-"/.___--Depth-.-..�.�---------------- � Cesspool: Distance ..prom nearest well-----------------Distance from foundation--------------------Lining material--------__----__---._---..--_.-------. El Size: Diameter_--'----------------------------------Depth-------------------- Liquid Capacity gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ---------------------- Q ❑ Distance to nearest lot line----- - ------------ - ------ ------------------------------------------------------------- -------------------------------------------- Remodeling and/or repairing (describe}:_...__-- -----�Y�Q_.._-C_�Y_j T1- f�--------Aee--V-,,1,4e------------------------------- 3 -------------------------------------•------------------------------------------------------------------------------------------------------•------------------------------------------------------------- - - - ----- -------- ---------------------------------------------------- ----------------------------------------------------------------------------------- --------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat s, an rules and regulations of the San Joaquin Local Health District. r-- (Signed)------------------------A _ .Rj-`�/ fi � �� = Ow rand/or Contractor) By:------------ -- - - r---------------------------------------------------------------(Title)----- - {-k------- ---- - --------------------- (Plot plan, showing size of lot,,locati n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY (n ., r APPLICATION ACCEPTED BY---------- -------------------------------------------------------------------------------- DATE------!-f-�--- REVIEWEDBY--------------------------------------------- - -- - ----------- ---------------------------------------- DATE-------- -------- ------------------------------------------ BUILDING PERMIT ISSUED-------------------- -------- - DATE------------------------------------------- . Alteratiarls and/or �commendations:______.. __ ._._ -----_-_.- �y _____,�__=r--_�-,/ .__z-------------/,. - .a - •---- ------------------------------------------------------- -------------------------- -------------=----------------------- -- --- -- ------------------------------------------------------------------------------------------------ ---------------------------------- I FINAL INSPECTION BY:-._ . ___ __ �� =- ' ��J `"�'r`� ,�- /___ !� / Date----= - - - - - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 911h Street Stockton,California Lodi,California Manteca,California Tracy,California • r.R.co.