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FOR OFFICE USE: 'r •----------------- -- ---------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. " (Complete in Duplicate) a .I Date Issued .-.___._._.-_t----._------------------------------- This Permit Expires I_Year From Date Issued y /, : (,C-7 07 Application is hereby made to the San Joaquin Local Health District fora ermit to construct and install the work herein described. This application is made in eta compliance with County Ordinance No. 549. � . JOB'AD AND LO ATION ' r� --------------' '<" -------------------------------------- - .� :F r Owner's Name `. Phone. .. �� Address - -------- --------�- — ----- ----- ---- ! '{i 1 - �G{_ - - Contractor's Name------------------= ---------- •----- ------ @�--------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer" E] Motel E] Other ❑ Number of living units:l__ ____ Number of bedrooms _.2,Number o-baths . .._ Lot siie,__--_-``�_' � C z = ---------------------------- Water Supply: Public system::❑ Community system r❑—Private� Depth to Water Table ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sagnply Lo E] Clay-Loalm Elay E] Adobe "rdpan Previous Application lade: (if yes,dote----- --------------) NoNew Construction: Yes No ❑ FHA/UA: Yes ❑ Noi❑--- TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic"'tanE or cesspool.perrhitted if public sewer.is available within 200 feet.) + Sep�ty�icy�Tyt4: Distance from nearest well --------Distance from foundation Material.......... '�K_ No. of compartments Size Q quid depth------'------------------Capacity--- - ----- Distance - Disposal i.eld Distance from nearest we11. ..__.__Distance from fo.undation________...--__-.-.Distance-to nearest lot line,-----_________f"`,� • �' Number of lines_____________ --- ------Length of each line------[ 0----------------Width`of4trench----------�- ---------------- Q 5 / �. Type of filter material__ '?�� _�TL-Depth of filter material___. __.______..Total length_____._.1- ________ ,r,.,a.....,77 Seepage Pit: Distance to nearest well-------------_--------Distance from foundation--------------------Distance to nearest lot line__-___.______.__ ,❑ Numberk of pits.------ ------Lining material-----------------------Size: Diameter-----------------------Depth------__----------------------- Xx Cesspooh W,Dista nce„from-nearest well-----------------Distance from foundation....................Lining material---__-_____--..-----------..---- e - _. N __.______.._------------------'-.-'---- Liquid Capacity----------------------------g a..l.s_.El Size: Diameter. --------- pth ea Privy: Distancf-ram' nearest we]....7---------------------------------------.----Distance from nearest building----___--------.--------------------- -❑ Distance to nearest lot Ione--------- -------- ---- -------'� - Remodeling and/or repairing`(describe):-- -------- -------------------------------------------------- -_=----------------------------•------------------------------- ---------------------- I - ----------------------------- ---- ----------------=-------------------------------------------------------•------------------- ------------------------------------------------------------------------------------------------ - - ----------------=------------------ --- -- --- °-----t------------------ ----------------------------------------------------------------------------------------- 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 rales and regulations of the San Joaquin Local Health District. (Signed) -- ` """ ---"" '"----- --------------------------- --- -- ------------------. - --- Owner and/or Contractor BYII--------------------------------------------------------- ------------------------------- ------=(Title)----------------- ----------------------------------------------- (Plot plan, showing size of lot,',location of system in relation to wells, buildings, etc., can be" placed on reverse side). h FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY------------rt-'------------- - -------'--------------------------------------- DATE-----��-1��---..`��------------- REVIEWEDBY-------------------------` ----- t -------------------------- DATE------------------------------------------- BUILDINGPERMIT ISSUED---=--------------------------------------------f------- ------------------------- - ------I--------- DATE---------------------------------- ---------------------- --- Alterationsand/or recommendations--------------- ' --- ---------- -- - - ----- ---------------------------------------------------I--•------------------------------'------------------------- i - I -------------------------------- '--------'-`---- •:.- ------------------ -------- ---------------------------------------------------------------------------------------------------------------- 1 : t 11NAL-INSPECTION"BY:.'"!'.. .:_ "� ---------- Date---'-- ------ ---------------------- I�• SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 'IF 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California k F.P.CC. 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