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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. t - _!_..... ------------------------------- ------------------------ (Complete in Duplicate) �j Date issued ----------------------------------_._-_.-----------_._ This Permit Expires i Year From 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 in compliance with County Ordinance No. 549. -fJ - ®OS- 130-2--y - w JOB ADDRESS AND fLOCATION--- ------------------ --------_rvt.<.f--------------------------- ---------- ---------------- -----------•--------------- l � - - - Owner s Name d ✓ ---- ---------jr_ -------------------------Address ' Contractor's Name f r - Phone : . - ------ ----------------------------------------------- Installation ----- ___________________________--- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: ---I!---- Number of bedrooms ---Z. Number.of baths ___ Lot size f_ __I__ `__c _. Z_________________________________ Water Supply: Public system ❑. Community system ❑ Private 0 Depth to Water Table _ __ ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam M Clay ❑ Adobe❑ Hardpan 0 M Previous Application Made: [If yes,date-----------,--------) No ❑ ! New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) » -- t Septic Tank: Distance from nearest well-:F(9_----------Distance from foundation-- ® foundation-_- /0_______._. Material___ Capacityl ___._o___a________---------- _t - ' No. of compartments------ depth_-----y-----------.---- Disposal - _ Field: Distance from nearest we€i__Ga.-----------Distance from foundation___ &-----------Distance to nearest lot yine30----------- ❑/ Number of lines--------e- -----------------------LengfK'of each line-- --_ry.b__._.-.-------Width of trench----�_-_:s------------------_-.-. Type of filter material-,4_-P'_______________Depth of filter material-___E __-.___.___Total lengfO _O-----_____-__________..______- U Seepage Pit: Distance to nearest well__/_fi_'..'D-------------Distance from foundation--ZPq-----------Distance to nearest lot line__�61--._-_... © Number of pits _____________Lining ----Sizer Diameter____13.°__.__..--_.Depth-,1-.-� ___.._____------.-__.. � Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------.--_...____._____________--- ❑ Size: Diameter--- _-------------------------------Depth----------------------------------------------------Liquid Capacity------------•--------------gals. Privy: Distance from nearest well ______________.------------------------------ Distance from nearest building---------_---__--______________..____._. ❑ Distance to'nearest.lot lire.-------- --:-:_-------------------------------- ----------------------------------- ------------------- --------------- ------ Remodeling and/or repairing (describe)---- --------------------------------------- ------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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) C�7,n &-, v -�tcf'C�Y'.'�------------ ---- --- ------------------------ ----------------(Owner and/or Contractor) g )-------- SY ---- - --- --- ----------- --------------- --- ------------- (Title) (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY .APPLICATION ACCEPTED BY---/1c --i--. ._-_----- ------------ --------------------------- DATE_-/- = -------- REVIEWED BY-------------------------------------------- ---- ------------------------------------------------------------------------- DATE------ --------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------ --- DATE---------------------------- ---------------------------------- ------------------------- Alterationsand/or recommendations:----------------- - -------------------------------------------------------------------•-•----------- ---------•------------------------ -------------------- --------•----------------------I-------- --------------------------------------------- --------- ---- --------------------------------------------•--------------------------•-----------------------------•------------------ ---------------- ------------------------- --- -- --------------------------- ---------------------------- ------------------•------------------------------------------------------------------ ----------------- --- ---- ---------------------------- --------- -------------------------- ---------- -------------------- ---------------- -------------------------------------------------- ------------------------------------------ FINAL INSPECTION BYE' .-^ ---- --------------------- Date-//-Z- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California f t